MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

Jódpovidon - topické aplikace

Jodpovidon jodid - neutrofily

  • Povidone-iodine solutions of greater than or equal to 0.2 per cent resulted in total inhibition of migration under agarose. This was caused by the cytotoxic effects of the solutions as shown by pyknosis and cell lysis. Lower concentrations of povidone-iodine, however, did not adversely affect neutrophil viability or locomotion.
  • beva.onlinelibrary.wiley.com/doi/abs/10.1111/j.2042-3306.1987.tb01387.x

COVID-19: Intranasal Povidone-Iodine / Drop in Flu / Vaccine Trial Details

  • By Kelly Young
  • Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
  • www.jwatch.org/fw117046/2020/09/17/covid-19-intranasal-povidone-iodine-drop-flu-vaccine
  • Intranasal povidone-iodine:
    • A 15-second treatment with an experimental povidone-iodine nasal antiseptic solution
      • Appears to inactivate SARS-CoV-2
        • JAMA OtolaryngologyHead & Neck Surgery
  • Effect was seen with povidone-iodine concentrations as low as 0.5%
  • Skin formulations could be toxic if administered intranasally
  • Antiseptic should not be used in
    • Pregnant women,
    • Patients with thyroid disease
    • Those undergoing radioactive iodine therapy
  • Transnasal viral inactivation
    • may prevent person-to-person spread of SARS-CoV-2
    • may also diminish the severity of disease in patients
      • By limiting spread and decreasing viral load delivered to the lungs
  • Povidone-iodine nasal irrigation
    • May be beneficial for the population at large as an adjunct to mask usage as a means of virus mitigation.
  • Randomized trials are under way.

Expanding the Role of Povidone-iodine in a COVID-19 Era; Jesse Pelletier

  • Published Online: August 21st 2020 US Ophthalmic Review. 2020;16(2): Online ahead of journal publication
  • www.touchophthalmology.com/cornea/journal-articles/paediatric-vernal-keratoconjunctivitis-the-vektis-study/
  • Antiseptics, such as povidone-iodine (PVP-I), are now routinely employed and will play a greater role in the future of healthcare.
  • Due to its ability to protect both patients and healthcare providers alike, PVP-I utilization
    • Oral and nasal solutions
  • Should be considered as an additional and expansive step in the standard precautions algorithm.
  • COVID-19 eye findings
  • Cases of conjunctivitis and keratoconjunctivitis have been reported
  • Similar to other viruses that are found in tears
    • Such as adenovirus, herpes simplex virus, influenza, and SARS-CoV
    • SARS-CoV-2 has been identified in ocular secretions
  • Poor correlation between active COVID-19 and its presence in tears
  • ACE2 and transmembrane serine protease 2 on the ocular surface
  • It is possible to transmit through ocular exposure
  • Levels of ACE2 are highest in nasal goblet and ciliated cells
    • Upper airway may be preferentially infected early in the disease
      • Making these cells a potential reservoir for SARS-CoV-2 infection
  • SARS-CoV-2 is an enveloped virus
    • Its release does not require cell lysis
  • The virus can exploit existing secretory pathways in the upper respiratory tract
    • To induce low-level infection that generates virus-laden droplets and aerosols in patients with no overt pathology
  • Povidone-iodine (PVP-I)
    • Broad-spectrum antiseptic with no known resistance
    • Listed by the World Health Organization as an essential medicine
    • Available in both developed and developing nations alike
  • PVP-I products have a long history of utility because of strong
    • Antiviral, antifungal, and antibacterial properties
    • Harnessed potency of the halogen, iodine
    • PVP-I is broadly virucidal
  • Nasal/oral formulation has been shown to rapidly deactivate SARS-CoV-2 in vitro
  • PVP-I has been used safely in the
    • Nasal cavity,
    • Sinuses,
    • Orally to treat a variety of conditions
  • Dilute PVP-I sinonasal rinsing solution
    • Has been shown to be a safe
      • Effective ancillary therapy for recalcitrant chronic rhinosinusitis
      • Oral decontamination
  • PVP-I gargle and mouthwash demonstrate strong bactericidal properties
  • Oral virucidal studies underscore its efficacy
    • Outperforms other antiseptics such as chlorhexidine and benzalkonium chloride
  • Gargling with PVP-I is common practice in Japan
    • Prevention and treatment of upper respiratory tract infections caused by influenza-like illnesses and the common cold
  • Gargling
    • Decrease the transport of bacteria into the trachea
  • PVP-I rinsing of the oropharyngeal tissues prior to intubation
    • Leads to a lower rate of ventilation-associated pneumonia
  • PVP-I may provide a protective oropharyngeal hygiene measure for individuals at high risk of exposure to oral and respiratory pathogens
  • 1% w/w mouthwash every 2–4 hours
  • 0.45% w/w “sore throat spray”
  • MRSA decolonization prior to performing ophthalmic surgery
    • Approach should be expanded with PVP-I
      • Especially adopted when preparing patients for surgical procedures or in any other setting that may create aerosols
  • All medical personnel should consider routinely using PVP-I iodine nasal and oral preparations
    • To decrease asymptomatic viral shedding
    • To mitigate further disease spread
    • Possible to create safe, effective, and comfortable protocols with repeat dosing of PVP-I, which may decrease the risk of transmission.
  • It should be accepted that one decontaminates the oral and nasal tissues prior to donning a mask

Gargling With Iodine May Help Fight COVID-19

  • Dr. Mark Sircus AC., OMD, DM(P), is a Professor of Natural Oncology, Da Vinci Institute of Holistic Medicine, Doctor of Oriental and Pastoral Medicine, and Founder of Natural Allopathic Medicine.
  • worldhealth.net/news/gargling-iodine-may-help-fight-covid-19/
  • Posted on Oct 09, 2020, 12 p.m.
  • A small randomized controlled trial
  • Gargling with povidone-iodine clears the virus from the nose and throat within four days
  • This result comes as no surprise because, for a century, doctors have known that iodine is effective, not only for bacterial and fungal infections but for viruses as well.
  • 20 asymptomatic or pre-symptomatic COVID-19 patients from a Malaysian university hospital were randomly allocated into four groups:
    • Group A gargled with 10 milliliters of 1% povidone-iodine for 30 seconds, three times per day
    • Group B did the same with 20 milliliters of Listerine.
    • Group C did the same thing, with 100 milliliters of tap water.
    • Group D acted as untreated controls.
  • On day 4
    • 100% of those in the povidone-iodine group had cleared the virus
    • 80% of those in the Listerine group
    • 40% of those in the tap water group
    • 20% of those in the control group had cleared the virus.
  • On May 26, another study was released, providing the first direct evidence that povidone-iodine is capable of killing SARS-CoV-2
    • 0.5% povidone-iodine completely inactivated the virus in 60 seconds
      • Comparable to 70% alcohol
    • Greater concentrations were equally effective but provided no additional benefit.
    • In vitro study, testing the ability to inactivate the virus when infecting isolated cells from the kidneys of African green monkeys
  • Povidone-iodine is traditionally used topically
    • Study does not provide any basis to suggest it should be swallowed orally
      • Might cause diarrhea or worse in large amounts
      • Povidone-iodine is not for oral consumption !!!
        • But Lugols and Nascent Iodine are.
  • Seventeen clinical isolates of Mycobacterium tuberculosis were tested
    • Povidone-iodine (PVP-I) at a concentration of 0.2% killed 99.9% or more of all strains tested within 30 seconds
    • All of the strains tested with PVP-I were killed almost entirely within 60 seconds
    • There was no difference in bactericidal activities of PVP-I between standard strain H37Rv and MDR-TB
    • Concluded that the commercially available PVP-I product is a useful antiseptic against MDR-TB similar to other M. tuberculosis.
  • Iodine kills 90 percent of bacteria on the skin within 90 seconds
    • its use as an antibiotic has been ignored
  • Iodine exhibits activity against bacteria, molds, yeasts, protozoa, and many viruses
    • Of all antiseptic preparations suitable for direct use on humans and animals and upon tissues, only iodine is capable of killing all classes of pathogens
      • Gram-positive and gram-negative bacteria, mycobacteria, yeasts, and protozoa.
      • Most bacteria are killed within 15 to 30 seconds of contact.
  • Iodine supports our immune systems in fending off invaders while it improves our immunity, so we are less susceptible to symptoms and illness.
  • Someone who is iodine sufficient has a lower chance of catching MRSA in a hospital
    • Superbugs like this will not thrive in a body with enough iodine
  • Virus responsible for Hashimoto’s thyroiditis — the Epstein-Barr virus (EBV) and all other viruses
    • Do not like iodine because it gets in the way of their advancement
  • Early 1900s, the Encyclopedia Britannica described iodine as being “of definite value” for treatment of multiple conditions including
    • “metallic poisonings, as by lead and mercury
    • Asthma,
    • Aneurism,
    • Arteriosclerosis, angina pectoris,
    • Gout,
    • Goiter,
    • Syphilis,
    • Hemophilia,
    • Bright’s disease (nephritis)
    • Bronchitis”
  • With “usual doses” of iodide salts ranging from
    • “five to thirty grains or more” (324mg to 1,944mg )
Odpovídá českému 2-3% kalium iodati dávkování 1-4 polévkových lžic/den a tam je ještě psáno, max. 5 dní po sobě
      • Though this is hundred of times higher than what is considered generally safe per today’s tolerable UL
  • Dr. Gabriel Cousens states, “Historically, as early as 1911
    • "people normally took between 300,000-900,000 micrograms daily without incident”
      • Translating into between 300 and 900 milligrams.
    • Most people today, even if they are fighting cancer
      • Only have the courage to use between 50 to 100 milligrams
  • Still, if you are fighting a life-threatening infection
    • We should remember medical history and how iodine has been used in the past
  • When we read that 30 to 60 times, these amounts have been used;
    • One should consider using a gram (1,000 milligrams) or even more when it is either that or death.
Naprostý souhlas. Lepší přechodná hypothyreóza nebo korigovatelná hypertyreozní epizoda, než umřít na sepsi nebo virovou pneumonii !!! Nebo od 20 let mít chronické srdeční selhání po difuzní nekroze myocytů a covidou plící ?

  • Nobel Laureate Albert Szent Györgyi, the physician who discovered Vitamin C in 1928, commented:
    • “When I was a medical student, iodine in the form of universal medicine. Nobody knew what it did, but it did something and did something good.”
  • Dr. Cousens concludes
    • “In 1950 the Japanese had 100 times more iodine in their diet than Americans.
    • In 2001
      • They had 202 times more iodine than Americans and were using up to 13.8 milligrams daily instead of the average U.S. intake of 425 micrograms.
    • There has been no real study, ever, about what is the optimal safe dosage of iodine.
      • But, again, no one has ever died from iodine overdose or allergic reactions.”


Iodine, a preventive and curative agent in the COVID-19 pandemic?

  • R.H. Verheesen and R.A.M. Traksel
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC7244430/
  • It has been known for a long time that iodine has unique germicide properties
  • During the Asian flu in 1957
    • Mandl’s paint
      • Seemed to prevent the development of influenza
      • Untreated group 14% developed influenza
      • Mandl's group only 2.8%
    • In already developed influenza, starting iodine after three days of illness
      • Reduced the number of cases significantly compared to the control group
      • Effect being clear after only two days of treatment
  • Pathophysiological research shows that iodine
    • Could support the innate immune system in fighting both bacterial and viral infections
  • 2013 it was shown in newborn lambs inoculated with respiratory syncytial virus (RSV)
    • Iodine treatment resulted in less lung lesions and less pulmonary expression of RSV antigen
  • In 3-week-old lambs it was demonstrated that iodine supplementation
    • Reduced the severity of RSV-infection
  • epidemiological data show that in the current COVID-19 pandemic the Japanese, known for their high iodine intake
    • Have a very low number of COVID-19 deaths compared to other countries
      • Despite the fact that
        • Japan has the eldest population of the world
        • National lockdown has thus far been one of mild measures
        • Už mne napadlo, zda tam lidé kvůli oné jaderné katastrofě třeba ještě někde donedávna neužívali nebo ještě někde neužívají jód i preventivně - jen neumím japonsky, abych si to mohla dohledat...
  • Pathophysiological, clinical and epidemiological data, we hypothesize that
    • Iodine is a crucial element in the optimal functioning of the innate immune system
    • Could be the magic bullet for fighting the COVID-19 pandemic
      • In both a curative and preventive way
  • Prevention might be reached easily because of
    • Very limited side effects
    • Fast uptake by oral supplementation
  • Iodine deficiency is estimated to affect one third of the world population at the moment.
  • High death rates, the high costs of healthcare and the enormous economic consequences of the current pandemic situation
    • It is important to conduct studies as soon as possible
      • Especially because this possible new treatment is simple, inexpensive and safe.
ANO, ANO, ANO !!! To je přesně to, co už více než 14 dní píšu různým lékařům a istitucím v ČR !
Potřebujeme rychlý klinický test !! Já jsem na sobě jód už vyzkoušela a efekt s úlevou od všech respiračních symptomů se dostavil již an ne po pár hodinách !!!


Povidone Iodine (PVP-I) mouth gargle/nasal spray may be the simplest and cost effective therapeutic antidote for COVID-19 Frontier

  • Need an effective protocol for health workers against SARS CoV-2
  • Povidone-iodine (PVP-I) has effective virucidal activity by those receptors inhibition and direct kill the virus by membrane disruption
  • PVP-I gargle, nasal spray and eye drop in case of accidental exposure is well tolerated easy use and has 2-3 hours contamination protection properties
  • So, uses gargle and nasal spray every 3 hours during shifting duty of health care provider which will cover the total protection and reduced social contamination.
  • Povidone Iodine is Polymer Polyvinylpyrrolidone (PVP-I) well tolerated
    • Strong anti-viral effect against SARS-CoV, MERS-CoV and recent SARS-CoV-2
  • Like RBCs and type II alveolar cells (AT2) of lung, this CD147 also present in
    • Tear and ocular tissues, like conjunctiva, corneal epithelium, endothelium, keratocytes, and retinal pigment epithelium
    • But ACE 2 receptor absent in such healthy ocular tissues
  • Some shorts of upper respiratory tract infection due to binding of SARS CoV-2 with CD147 in ocular tissues
    • Then drain into nasal cavity via nasolacrimal duct
  • Study demonstrate virus found in tear/conjunctival specimen is 1.949% of total COVID19 patients
  • In China almost 31.6% of patients with COVID-19 had ocular involvement
  • 91.7% of the patients with COVID-19-related conjunctivitis tested positive on a nasopharyngeal swab
  • Inhibitory effect of PVP-I on
    • Hemaggulitinin(HA) protein mediated ACE2
    • Transmission decline the cross infection
  • Lipid bi-layer envelop The beta-coronaviruses contain several Hemagglutinin Esterase (HE) protein
  • Abundant ACE2 receptor is identified in oral tissues especially in
    • Epithelial cells of tongue,
    • Type II alveolar cells (AT2) of lung
    • Esophagus upper,
    • Stratified epithelial cells,
    • Heart, lungs, kidneys, and gastrointestinal tract
    • Lymphocytes of oral cavity
    • Salivary glands which is an early target for SARS-CoV-2
  • Prophylactic mouth rinse/gargle and nasal spray
    • Inactivate the heamaggulitin esterase activity
    • Enhance absorption of ACE2 as receptor of host cell infection
  • Topical povidone iodine along with dexamethasone
    • Was found to be very effective in rabbit adenoviral conjunctivitis
  • In clinical settings, PVP-I (1% and 5%) already showed clinical benefit in cases of adenoviral conjunctivitis
  • 1% topical PVP-I (eye drop) on stat dose has prophylactic or preventive role of during accidental ocular exposure to SARS CoV-2
  • Few well-designed studies have established the efficacy of PVP-I eye drops in viral conjunctivitis
  • Burning and irritation is a significant side effect of the drug
    • Can be effectively reduced by diluting 1 mL of 5% PVP-I with 4 mL of BAK containing lubricant drops
    • This formulation will ensure patient comfort
    • Will have the advantage of dual antiviral action with BAK and PVP-I
  • PVP- I (1%) was effectively reducing the infectivity of both SARS-CoV and MERS-CoV in a invitro studies
    • SARS-CoV for one minute
    • 15-second for MERS-CoV
      • Viral infectivity to below detectable level
  • Dilution in aqueous solution PVP-I complex releases free iodine
    • Which oxidizes fatty acid of viral cell wall
    • Deactivates cytosolic enzymes of respiratory chain
    • Inhibits the inflammation of host tissue
  • Suspected or confirmed COVID-19 patients
    • 0·5% PVP-I solution (0·55 mg/mL available iodine) be applied to the oral, oropharyngeal and nasopharyngeal mucosa
  • 1 mL of 5% PVP I with 4 mL of BAK containing lubricant drops stat dose
    • During accidental eye exposure or contact decrease the risk for contamination at remarkable level
  • 0.2% povidone iodine may reduce the risk of ventilator pneumonia
  • 0.5% PVP-I gargle once or twice a day up to six-months
    • Showed no alteration in thyroid hormone levels (serum T3/T4 and free T4) but small increase in TSH levels within normal range
  • Pediatric patient below 6 years not recommended
    • 6 years or above may use single episode of PVP-I if mandatory
  • It would be very cost effective defending front line health workers
  • live clinical trial of USA, UK, Japan, New Zealand
    • Every health worker,
    • COVID-19 patient,
    • Suspected patient with family
    • Any nursing personnel
  • will be protected from risk of SARS-CoV-2 transmission
    • By using prepared saline diluted 0.4% to 0.23 % gargle and nasal spray (1:1.5 dilution of 1% and 1:30 for 10% PVP-I)
    • Two spray in each nasal cavity and feel it in throat
    • hold it for 30 seconds
    • followed by gargle for 30 seconds and should avoid eat or drink till 30 minutes
  • Person who staying or related to COVID-19 patient including asymptomatic COVID-19 patients or has transmission risk
    • All should continue the PVP-I gargle and nasal spray in every 3 hour or 4 times a day
  • There is evidence of 0.4% to 0.23%
    • Has no side effect even continuous use of 3 month to 2 years
  • More over, gag reflex and unconscious cases may be recommended 0.4%-0.5% throat spray

Povidone-iodine solution as SARS-CoV-2 prophylaxis for procedures of the upper aerodigestive tract a theoretical framework

  • Syed H. S. Naqvi, Martin J. Citardi, Davide Cattano, Luis Ostrosky-Zeichner, Mark I. Knackstedt & Ron J. Karni
  • Topical oronasal treatment with povidone-iodine (PVP-I), better known as Betadine™ (Avrio Health, LP)
  • May be an effective method to immediately reduce the viral load of the upper aerodigestive tract and thus decrease the risk of inadvertent virus transmission.
  • Eggers et al. reported that a 1% PVP-I gargle for 15 s reduced
    • Middle East respiratory syndrome-related coronavirus (MERS-CoV) titer by greater than 99.99%
  • 2018, Eggers again demonstrated that both Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) and MERS-CoV
    • could be rapidly inactivated by PVP-I in concentrations as low as 0.23% applied for 15 s
  • Other authors have reported similar viricidal effects on
    • Influenza,
    • Rotavirus,
    • Ebola,
    • HIV,
    • Adenovirus,
    • Polyomavirus,
    • Hepatitis A
    • Klebsiella pneumonia
    • Streptococcus pneumonia
  • Nagatake et al. reported
    • 50 % reduction in Pseudomonas aeruginosa
    • Staphylococcus aureus
    • Hemophilus influenza in 23 adults with chronic respiratory conditions by PVP-I gargling four times daily
  • Shiraishi et al. reported a significant decrease in absence rate due to
    • Common cold
    • Influenza in a middle school where the use of PVP-I gargle was encouraged
  • Ogata et al. compared bacterial levels in the oropharynx at intubation and at the tip of the endotracheal tube after extubating
    • Among patients using PVP-I gargle or tap water gargle
    • The bacterial levels in the oropharynx at intubation were markedly lower in the PVP-I gargle group
    • Tap water gargle patients had higher levels of bacterial colonization of the endotracheal tube tip
      • 26.1% of tap water gargle patients versus none in the PVP-I gargle group for level 3 or 4 bacterial colonization
  • Oral PVP-I gargle formulations are currently available in many countries, including
    • Japan and Canada
  • Rare cases of aspiration pneumonitis as well as thyroid dysfunction
    • Have been reported as side effects to povidone-iodine
  • Cases of anaphylaxis, contact dermatitis and edema after exposure
    • Have also been reported
  • Ingestion in high concentrations or quantities may lead to
    • Acute kidney injury and/or liver toxicity
  • PVP-I in low concentrations
    • Has not been known to stain teeth
  • Topical oro-nasal PVP-I prophylaxis
    • Should not be considered in patients with iodine allergy
    • Or those undergoing radioiodine treatment
  • Study of PVP-I oral gargle for cancer-associated oral mucositis
    • no mucosal irritation was reported
  • PVP-I is ciliotoxic in concentrations of 5% and 10%
  • Proposed prophylactic treatment
    • Prior to the induction of anesthesia, each patient self-administers PVP-I as follows:
      • 15 ml 1% PVP-I as a swish and spit for 30 s
    • After general anesthesia has been induced,
      • 1% PVP-I solution is applied to oral cavity, oropharynx, hypopharynx and laryngopharynx surfaces
        • For all transoral procedures or other procedures that cross these mucosal surfaces
    • 10–20 ml 1% PVP-solution is placed into the nasal cavity (for any transnasal procedure).
      • Mucosal contact of the PVP-I solution is maintained for 30 s.

Povidone-iodine

  • Iodine in the form of a complex with the binding iodophore - polyvinylpyrrolidone
  • Has a greater spectrum of antibacterial and antiviral effects than other known antiseptics
  • Active against many types of viruses, including
    • HIV, in in vitro suspension experiments
      • [Kawana R. et al., Inactivation of human viruses by povidone-iodine in comparison with other antiseptics. - Dermatology, 1997r., 195, App. 2, pp. 29-35] [11]
  • Anti-infective agents containing povidone iodine can be used to combat
    • HIV,
    • Chlamydia,
    • Gonococcus,
    • Treponema
    • Herpes simplex virus
      • [Tsutomu S., Junko S. Anti-infective against STD relating, for example, to HIV, Chlamidia, gonococcus, treponema pallidum or herpes simplex and device used to preserve / mix principal ingredient and base of such anti-infective - EP 0823996A1, A 01N 59/12, A 61 K 9/00, application. 08/15/96, publ. 02/18/98 and Shanbrom E. Antiviral, spermicidal vaginal gel and foam containing low molecular weight povidoneiodine. US 5545401, A 61K 31/79, A 61 33/18, application. 06/02/94, publ. 08/13/96]. [11]

Prevention of COVID-19 Infection with Povidone-Iodine

  • Luis Mendoza; Date Written: April 30, 2020
  • Povidone-iodine (PVP-I) is an antiseptic that has primarily been used for the prevention or management of wound infections for over 150 years.
  • Its antibacterial, antiviral, and antifungal properties and its safety have been well-documented.
  • This article reviews the studies that
    • Have assessed the antiviral efficacy of PVP-I
    • Its potential use as a prophylactic on the oropharyngeal and nasopharyngeal mucosa of
      • Healthcare workers,
      • COVID-19 patients,
      • Community as an additional measure to help abate the pandemic.
  • papers.ssrn.com/sol3/papers.cfm?abstract_id=3589404

Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic

  • Mubarak Muhamed Khana, Sapna Ramkrishna Paraba
  • www.sciencedirect.com/science/article/pii/S0196070920303124
  • Iodine has been recognized as an effective bactericidal agent since the 1800s.
  • Povidone iodine (iodine with the water-soluble polymer polyvinylpyrrolidone, PVP-I)
    • Discovered in 1955 at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski.
    • Developed so as to find an alternative form of antimicrobial iodine complex that was less toxic than tincture of iodine
  • The onset of antimicrobial action of PVP-I starts when
    • Free iodine dissociates from the polymer complex
    • The free form of iodine rapidly penetrates microbes disrupting proteins and oxidising nucleic acid structures
      • Resulting ultimately in microbial death
  • PVP-I antibacterial activity is enhanced by
    • Dilution of the usually available 10% w/w cutaneous solution
      • From 1:2 dilution up to a 1:100 dilution (0,1%)
        • With a reduction in activity occurring beyond 1:100
  • PVP-I has higher virucidal activity than other commonly used antiseptic agents including:
    • Chlorhexidine
    • Benzalkonium chloride
  • PVP-I has been shown to be
    • Active in-vitro against the coronaviruses that have caused epidemics of SARS and MERS
  • PVP-I against MERS-CoV
    • Lowest concentration of PVP-I to be effective was 1% when used for 30 s under “dirty” conditions
      • Leading to a reduction of viral activity of 99.99%
    • But not effective at 0,1%
  • In subsequent in-vitro work by Eggers et al.
    • lowest concentration tested and effective against coronaviruses was 0,23%
  • Kariwa et al. showed that in vitro treatment of SARS-CoV with various preparations of PVP-I for 2 min
    • Reduced the viral activity to untraceable levels
    • lowest concentration throat spray (Isodine Nodo Fresh®) of 0.23% was used in Japan
  • In many orthopaedic and ophthalmic surgeries PVP-I is used
    • As preoperative agent for Decolonization of Nasal Staphylococcus aureus and many infections
    • In many ophthalmic surgeries, different dilutions of PVP-I are used for avoiding contamination and it is well tolerated
  • Oropharynx and nasopharynx are the target sites of novel coronavirus
    • Saliva contains a high viral load of COVID 19 with up to 1.2 × 10na 8 infective copies/per ml
  • Even a few microliters of saliva contamination of surfaces or instruments
    • May carry many thousands of infectious viral particles
    • Asymptomatic, the viral shedding initial phase of COVID 19 is highly infectious
  • Povidone Iodine (PVP-I) has better antiviral activity than other antiseptics in SARS –CoV and MERS-Cov
    • We propose the use of 0.5% PVP-I as gargles and nasal drops
      • As a prerequisite for patients attending ENT Out-Patient department and health care workers attending these patients.
  • Kontraindikace - vyloučení ze studie:
    • Patients with history of allergy to PVP-I
    • All forms of thyroid disease
    • On radioactive iodine treatment
    • lithium therapy
    • Known pregnancy
    • Renal failure
    • Dermatitis
  • The protocol can be used in children as a single application for Nose, Throat examination after excluding allergy.
  • Hospital setting, we propose
    • Application of 0·5% PVP-I solution (0·55 mg/mL available iodine)
      • As gargles onto the oral, oropharyngeal mucosa and as nasal drops onto nasal and nasopharyngeal mucosa of patients
    • Application of 0.5% PVP-I can be used for
      • Oral surgery, ENT examination and treatment, endo-tracheal intubation, endoscopy and bronchoscopy as a preoperative preparation.
  • Preparation of 0.5% solution of PVP-I from commercially available solution:
    • Povidone Iodine IP 10% v/w in purified water IP q.s.: Use 1 ml of PVP-I in 20 ml of sterile water/purified water.
    • Povidone Iodine IP 5% v/w in purified water IP q.s.: Use 1 ml of PVP-I in 10 ml of sterile water/purified water.
    • Povidone Iodine IP 7.5% v/w in purified water IP q.s.: Use 1 ml of PVP-I in 15 ml of sterile water/purified water.
    • Povidone Iodine IP 2.5% v/w in purified water IP q.s.: Use 1 ml of PVP-I in 5 ml of sterile water/purified water.
  • For all patients/healthcare professionals:
    • 0·5% PVP-I solution is administered in a dose of 4–5 drops into each nostril 10 min prior to examination
    • For endoscopic procedure, nasal pack with PVP is used and prior nasal douching 2 times prior day.
  • Conscious patients and healthcare professionals:
    • 10 ml of the 0,5% PVP-I solution is then introduced into the oral cavity and used as a mouthwash
    • Care is taken to ensure the solution is distributed throughout the oral cavity for 30 s
      • And then gently gargled or held at the back of the throat for another 30 s before spitting out.
  • Patients hospitalised for confirmed/suspected COVID 19 and the involved healthcare workers:
    • Steps 1 & 2 should be undertaken every 6 h for patients
    • Up to four times per day for healthcare workers (maximal frequency two hourly)
  • For healthcare workers
    • Prior to contact with the patients
    • If repeated contact is occurring, steps 1 and 2 are at a frequency up to 4 times in a day or repeated every 2–3 h
  • Endoscopy and bronchoscopy and any other action to be carried out close to or in the mouth or nose:
    • The patient should undergo steps 1 & 2 prior to examination or treatment.
    • Healthcare workers conducting the procedure or in close proximity should perform steps 1 & 2 prior to contact with the patient and if multiple patients are being seen, repeat every 2–3 h, up to 4 times a day
    • Dosages are the same as above, but are single exposures for patients.

Results

  • No allergy was reported by any of the patients and health care workers.
  • PVP-I is being extensively used worldwide as a handwashing agent usually
    • 7·5% solution containing foaming agents
    • 10% pre-procedural skin antisepsis, oral surgery
    • 5% ophthalmic surgery
  • Commercially available in the Far East as a 1% w/v mouthwash for use every 2–4 h
    • 0·5% versus 0·23% will be effective to allow for dilution due to saliva
      • As the exact effective concentration of PVP-I in the presence of mucins and saliva is not known.
  • intranasal topical application of 0.08% solution of iodine
    • For the treatment of recalcitrant chronic rhinosinusitis has been described by the St. Paul's Sinus Centre team in Vancouver
    • Application did not cause any significant effect on thyroid function, mucociliary clearance or olfaction
  • There is absolutely no harm in repurposing 0,5% PVP-I
  • False negative test creates a pseudo feeling of security amongst the health care workers.
  • We do accept that direct testing and demonstration of the virucidal activity of PVP I against SARS-CoV-2 has not been yet documented.
  • However, the experience gained from the previous studies showing in vitro virucidal action of PVP-I in SARS COV and MERS
    • We propose to use it for reduction of SAR-CoV-2 viral load in the oral cavity
    • To prevent COVID 19 transmission in the suggested manner
  • A risk free time of 20 min following the use of PVP-I should be sufficient for examination and short procedures.
  • The question of total iodine exposure seems well within previously recorded safe limits in those without contraindications to its use
Od pročtení této studie přemýšlím o tom, že by mohlo být stejně zajímavé a ještě lepší vymyslet jodový roztok do inhalace, aby se topicky podáváný jod dostal i dolních cest dýchacích - například, když už je kašel !
I lokální použití jódu může mít velký význam. Takže pokdu se někdo bojí dát si kalium iodati kvůli vysokým dávkám jódu, další cestou je použití iodu lokálně na sliznice, kde bude také několik hodin dělat, co má, protože je to hlavně o tom, jak ho dostat na sliznici - budˇsekrecí z kreve při jeho velkých dávkách a nebo kapkama, klokátním a sprayem. Od této chvíle se mi hodní hlavou, jak by se dalo zařídit, aby se roztok s jodem dal aplikovat v inhalaci / nebulizaci !!! Aby se zkrátka dostal dolů do dýchacích cest, když už je virus pak i tam a dělá kašel !!! Je to cesta, jak SARS-CoV-2 rychle deaktivovat - za předpokladu, že máme na sliznici i dost SCN- (lze doplnit požitím vit. B17)

Preprocedural Use of Povidone-Iodine Mouthwash during Dental Procedures in the COVID-19 Pandemic

Coronavirus prevention: Iodine nasal wash and two other methods that can kill coronavirus, as per reports

Již se to doporučuje pacientům ! Super! Proč ještě ne v ČR?

Efficacy of “Essential Iodine Drops” Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2)

  • Zoltán Köntös
  • www.researchsquare.com/article/rs-69394/v1
  • EID (200 mcg iodine/ml) after exposure for 60 and 90 seconds was compared to controls.
  • In both cases, the viral titre was reduced by 99% (LRV 2.0)
    • The 1:1 dilution of EID with virus reduced SARS-CoV-2 virus from 31,623 cell culture infectious dose 50% (CCCID50) to 316 CCID50 within 90 seconds.
  • Substantial reductions in LRV by Iodine-V in EID confirmed the activity of EID against SARSCoV-2 in vitro
    • Demonstrating that Iodine-V in EID is effective at inactivating the virus in vitro
      • Therefore suggesting its potential application intranasally to reduce SARS-CoV-2 transmission from known or suspected COVID-19 patients.

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

  • Samantha Frank, Seth M. Brown, Joseph A. Capriotti at. all
  • JAMA Otolaryngol Head Neck Surg. Published online September 17, 2020. doi:10.1001/jamaoto.2020.3053; COVID-19 Resource Center
  • jamanetwork.com/journals/jamaotolaryngology/fullarticle/2770785
  • What is the minimum contact time of povidone-iodine (PVP-I) nasal antiseptic
    • For inactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro ?
      • 0.5% after 15 seconds of contact
        • Log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus.
  • Intranasal PVP-I rapidly inactivates SARS-CoV-2
    • May play an adjunctive role in mitigating viral transmission beyond personal protective equipment.
  • Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact
    • Ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact
  • Nasal PVP-I irrigations should additionally be considered for use by health care professionals for prophylaxis.
  • Oral mucosa decontaminated with PVP-I remains sterilized for up to 4 hours
    • Although this has not yet been proven in nasal mucosa
  • At concentrations of 1.25%, iodine absorption is negligible
    • Simple, nonbuffered, slightly acidic, complexed PVP-I solutions would further limit any transmucosal absorption of molecular iodine
      • Providing only a minimal theoretical risk of iodine absorption
  • Thyroid function testing should be considered when PVP-I is regularly administered to patients for more than 3 months.
  • Use of intranasal PVP-I is contraindicated in patients with
    • An allergy to iodine,
    • Patients who are pregnant,
    • Patients with active thyroid disease,
    • Patients undergoing radioactive iodine therapy

Betadine produkty a návody při COVID-19


Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Naso- Pharyngeal Viral Load in Patients With COVID-19

  • Source Poitiers University Hospital
  • Povidone-iodine is an antiseptic suitable for use on the skin and mucosa with potent virucidal activity, particularly against coronaviruses.
  • It is marketed for oro-nasopharyngeal decolonization.
  • 24 patients with positive nasopharyngeal SARS-CoV-2 carriage will be randomized (1:1) in an experimental group (benefiting from povidone iodine decolonization) or a control group.
  • Patients in the experimental group will be asked to
    • gargle with a 1% povidone-iodine solution
    • Spray their nose with the same antiseptic solution,
    • Finally applied 10% povidone-iodine cream in each nostril
    • All four times a day for five days
    • Patients will be followed for 7 days to evaluate the efficacy and safety of povidone iodine decolonization.
  • ichgcp.net/clinical-trials-registry/NCT04371965

EARLY VIRAL CLEARANCE AMONG COVID-19 PATIENTS WHEN GARGLING WITH POVIDONE-IODINE AND ESSENTIAL OILS: A PILOT CLINICAL TRIAL

  • NURUL AZMAWATI MOHAMED, NIZAM BAHAROM, WAN SHAHIDA WAN SULAIMAN at all.
  • doi.org/10.1101/2020.09.07.20180448
  • Preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
  • Gargling had been reported to have significant roles in the prevention and treatment of respiratory tract infections.
  • Pilot, open labeled, randomized, parallel study compared the effect of 30 seconds, 3 times/day gargling using
    • 1% povidone-iodine (PVP-I)
    • Essential oils
    • Tap water
  • On SARS-CoV-2 viral clearance among COVID-19 patients in a tertiary hospital in Kuala Lumpur
  • Progress was monitored by day 4, 6 and 12 PCR (Ct value), gargling and symptoms diary as well as clinical observations
  • Five confirmed Stage 1 COVID-19 patients were recruited for each arm
    • Age range was from 22 to 56 years old. The majority were males.
    • Two respondents had co-morbidities, which were asthma and obesity.
  • Viral clearance was achieved at day 6 in:
    • 100% - 1% PVP-I
    • 80% - essential oils
    • 20% - tap water
    • 0% - control group

The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Reduce Cross Infection and Protect Healthcare Workers

  • We suggest the protocol is considered for routine use during the care of COVID-19 patients
    • Particularly before any procedure that involves the upper aerodigestive tract, including
      • Intubation,
      • Nasal and oral procedures,
      • Endoscopy and bronchoscopy
  • In all patients during the pandemic regardless of COVID-19 status, due to the reported significant rates of asymptomatic infection
  • The total iodine exposure proposed is well within previously recorded safe limits in those without contraindications to its use.
  • The intervention is inexpensive, low risk and potentially easy to deploy at scale globally.
  • There is little to lose and potentially much to gain.

Povidone iodine formulations

  • A more potent form of iodine than Lugol’s
  • Limit the impact and spread of infectious diseases
    • Writes German virologist Maren Eggers (Infectious Diseases and Therapy, 2019; 8: 581-93) [7]


O úroveň výše

Poslední aktualizace: 27. 11. 2020 16:19:04