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Efficacy of oral ciprofloxacin as selective intestinal decontaminant in cirrhosis.

BACKGROUND: Selective intestinal decontamination has been proposed to prevent bacterial infection in cirrhosis. AIMS: To evaluate the efficacy of ciprofloxacin as selective intestinal decontaminant. PATIENTS AND METHODS: Quantitative microbiological studies on serial faeces were carried out in 15 cirrhotic patients. Ciprofloxacin was given orally at the starting dose of 250 mg every 12 hours for 7 days followed by a single dose of 250 mg/day from day 7 to day 14 and 125 mg/day for the next 3 weeks. Total stool samples were examined in basal conditions and on days 7, 14, 21, 28 and 35 of treatment and 3 and 7 days after treatment withdrawal. RESULTS: Gram-negative flora was completely eliminated in all patients by ciprofloxacin given at doses of 500 and 250 mg/day. When the drug was tapered to 125 mg/day, Escherichia coli reappeared in stools of 7 patients (antibiotic-resistant in one patient) and Klebsiella oxytoca in two patients (antibiotic-resistant in one patient). Faecal concentration of Group D Streptococcus was significantly increased at the end of therapy (basal mean 7.7 +/- 1.2 log CFU vs post treatment mean 9.6 +/- 0.5 log CFU, p < 0.05) while the faecal concentration of anaerobic flora and Candida albicans showed no change. CONCLUSIONS: Results of this study demonstrate the efficacy of oral ciprofloxacin as a selective intestinal decontaminant and ciprofloxacin 250 mg/day is the recommended dose for maintaining Selective Intestinal Decontamination. However, the risks of inducing antibiotic resistance in Gram-negative flora and promoting overgrowth of Gram-positive flora must be carefully considered in all patients chronically treated with oral quinolones.

Administration, Oral↗

Decontamination of gum arabic with gamma-rays or electron beams and effects of these treatments on the material.

Samples of gum arabic were irradiated to 2.5, 5.0 and 10.0 kGy with gamma-rays and electrons for a comparison of the relative effectiveness of these two treatments and for investigation of the effects of these doses of radiation on the material. The initial raw samples were contaminated with various strains of bacteria, including fungi and spore-forming bacteria (such as Enteroccus faecalis, Bacillus cereus and Closstridum perfringens). The samples were completely decontaminated by irradiation to 10.0 kGy with either gamma-rays or electrons. Slight changes in the physical properties of the material, such as darkening and viscosity decrease, were noticeable after irradiation to the highest dose, but not to the lower doses. A linear relationship between the absorbed dose and the material degradation was observed. gamma-rays were found to be more destructive than electrons. An optimal decontamination regimen for the material to be used in food industry and medicine would be irradiation to 5 kGy with electrons. It would be a safe alternative to the methods using hazardous chemicals, such as pesticides and fungicides. It would provide sufficient decontamination without adverse effects on the physical properties of the final products.

Bacteria↗

Decontamination.

Decontamination is the removal or reduction of chemical, biologic, or radiologic agents from the patient's skin, mucosa, lungs, and gastrointestinal tract. Decontamination is an important step in decreasing the clinical effects of the agent on the patient, as well as protecting coworkers from exposure. For most agents and the vast majority of scenarios, the removal of clothing and a simple 5- to 6-minute shower with soap and water is sufficient to eliminate the risks to the patient and hospital staff. In rare circumstances, additional steps in decontamination including gastric lavage, broncho-alveolar lavage, surgical removal of wound foreign bodies, and administration of activated charcoal, polyethylene glycol electrolyte solution, and radioisotope binding agents, may be necessary.

Allied Health Personnel↗

Development of a new approach for microbial decontamination of water using modified Fenton's reaction.

Microbial decontamination of water was carried out using a novel radical generating system consisting of ion exchange resin, copper and hydrogen peroxide. The system was successful in reducing the microbial load in water by more than 99% in 15 min and is effective against all the microorganisms tested. The method was also successful in decontaminating the flood water obtained from Industrial Canal and 17th Street Canal in New Orleans. Decontamination is due to the formation of hydroxyl radicals, formed during the decomposition of hydrogen peroxide by the metal-polymer complex.

Copper↗

Decontamination of surfaces by lysozyme encapsulated in reverse micelles.

Cells and enzymes can be used to decontaminate soil, water supplies, personal equipment, weapons and hospital equipment that have been exposed to bacteria, toxins or viruses. One of the problems associated with the use of microorganisms and enzymes for decontamination purposes is that the presence of water is not acceptable for some applications such as electronic equipment. One way of circumventing this problem is to allow the enzyme to distribute between a water phase and an organic phase-containing surfactant and then use the encapsulated enzyme in reverse micelles directly into the device to be clean. Reverse micelles were used to deliver the enzyme (lysozyme) to the cell-surface interface. They serve as a way to increase the local concentration of lysozyme and decrease the amount of water delivered. Specifically, we explored the lysis by free lysozyme and lysozyme encapsulated in reverse micelles of Klebsiella pneumoniae and Staphylococcus epidermidis attached to steel, glass, and hydroxyapatite. These two bacteria have been selected because they are known to be pathogenic and because of their differences in cell wall structure. Lysozyme was added to the surfaces in either reverse micelles or as a free solution and was tested under conditions of stirring and no stirring. Stirring was implemented to study the interplay between mass transfer limitations and surface roughness. We have shown that free lysozyme or lysozyme encapsulated in reverse micelles is capable of decontaminating surfaces of different texture. Lysis of the cells is slower when the encapsulated enzyme is used but lysis is more complete.

Decontamination↗

Long-term stability of decontamination effect in recreational areas near the town Novozybkov, Bryansk Region, Russia.

In 1995 and 1997, experimental decontamination campaigns were carried out in two recreational areas, Novie Bobovichi and Guta-Muravinka, near the town of Novozybkov, Bryansk Region, Russia. These areas were strongly affected by the Chernobyl fallout in 1986. In order to examine the long-term stability of the clean-up procedures, a programme has been carried out to continuously monitor the radiological situation in and around the decontaminated areas. This follow-up program consists of regular (1-3 times per year) measurements of absorbed gamma-dose rate in air (DR) at reference indoor and outdoor locations, repeated DR measurements on a grid, and gamma-spectrometric analysis of soil and other environmental samples. Very similar dynamics of the Chernobyl-related DR, mostly attributed to radiocaesium decay, were found in all the locations. For the period under study (September 1995-May 2003), the half-lives (years) for the reduction in radiocaesium-dependent DR contribution due to contaminant migration (in the following termed 'DRM half-lives') were, respectively, 52+/-26, 57+/-23, 43+/-21, 46+/-15, and 80+/-56 for the following locations: untreated outdoors, treated outdoors, untreated indoors, treated indoors, and undisturbed forest-grassland plots outside the recreational areas. These relatively high values of the current DRM half-lives correspond very well with the results of soil core analyses, which showed no time-dependent changes in the mean mass depths of the (137)Cs distribution, neither at treated nor at undisturbed plots. The following signs of natural restoration of the disturbed forest-meadow ecosystems have been observed at treated areas: formation of a new litter layer, development of grassy spots, mushroom growths and new generations of pines and birches. The levels of the (137)Cs content in grass and mushrooms from treated plots were one or two orders of magnitude lower, than those registered in the samples from untreated areas. The follow-up study demonstrates the long-term stability and efficiency of the decontamination carried out. There are two main reasons for the sustainment of the effects: careful implementation of adequate clean-up procedures and natural strong fixation of radiocaesium in soil-associated matrices of the ecosystems.

Agaricales↗

Application of SO(4)(2-)/TiO2 solid superacid in decontaminating radioactive pollutants.

Polyaniline doped with SO(4)(2-)/TiO(2) superacid shows good conductive ability. When used in a strippable coating film for decontaminating radioactive pollutants, the SO(4)(2-)/TiO(2) solid superacid replacing HCl exhibits higher electrical conductivity (7.01 s/cm) and a decontamination ratio higher than 97%. Coating and electrolyzing the film in solution or in dry medium were effective methods, the latter was more promising for decontaminating radioactive pollutants which were attached to the surface or within the body of equipments used in nuclear industry.

Aniline Compounds↗

Dispersion modeling of PM10 released during decontamination activities.

The decontamination and decommissioning of radioactively contaminated structures and facilities, volume reduction of massive metal structures, and demolition of large concrete structures, result in release of large quantities of contaminants that become airborne and thus could be inhaled by workers and population living in the neighborhood. In order to provide adequate protection to the workers, adequate monitoring of the airborne particulates and proper models that predict the dispersion of the airborne contaminants are needed. The dispersion model will enable development of decision tools on the extent of decontamination that needs to be performed prior to dismantlement and the optimization of personal protective equipment requirements during D&D operations. The Gaussian plume dispersion model is used in this study to predict the dispersion of airborne particulate PM10 (dp<10 microm) released from: (1) a 35 m height contaminant plant where the plume is affected by the presence of 36 buildings around the emission source, (2) a building during decontamination and removal of process equipment and (3) demolition of contaminant building. The potential impact of PM10 on 180 receptors located at five downwind distances between 0.1 and 20 km around the emission source was performed. A short-term (1-48 h) prediction of average concentration of PM10 from point and area sources on receptors located at ground level was obtained. The concentrations of PM10 over 24h time period were compared to the U.S. air quality standards. The results obtained in the course of this study are used to predict the inhalation exposures of workers and population living in neighborhood.

Air Pollutants↗

Photoelectrocatalytic decontamination of oilfield produced wastewater containing refractory organic pollutants in the presence of high concentration of chloride ions.

The feasibility study of the application of the photoelectrocatalytic decontamination of high saline produced water containing refractory organic pollutants was investigated in the slurry photoelectrocatalytic reactor with nanometer TiO2 particle prepared with sol-gel method using the acetic acid as hydrolytic catalyst. The efficiency of the photoelectrocatalytic decontamination of produced water was determined with both COD removal from the tested wastewater and the decrease of mutagenic activity evaluated by Ames tests. The experimental results showed that the photoelectrocatalysis is a quite efficient process for decontaminating the produced water, although there are high concentration of salt existed in oilfield wastewater. We found that the COD removal efficiencies by photoelectrocatalytic process are much higher than that of by photocatalytic or electrochemical oxidation individually in the photoelectrocatalytic reactor. The COD removal can be substantially improved by the added H2O2 and the generation of active chlorine from high concentration chlorides in the wastewater. The effects of various operating conditions, such as initial COD concentration, applied cell voltage, catalyst amount and initial pH value of solution, on the photoelectrocatalytic efficiencies, is also investigated in detail. The results showed that when the raw produced wastewater was diluted in a 1:1 (v/v) ratio, there is a highest COD removal efficiency. And the photoelectrocatalytic degradation of organic pollutants in saline water is much favored in acidic solution than that in neutral and/or alkaline solution.

Biodegradation, Environmental↗

Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations.

After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices. Review of existing databases, relevant published literature, and individual case reports reveal some provider health risks, especially when the exposure involves organophosphate agents. However, reported risks from secondary exposure to contaminated patients at health care facilities are low. These risks should be adequately addressed with Level C personal protective equipment, including air-purifying respirator technologies, unless the facility determines that specific local threats require increased levels of protection.

Decontamination↗

Decontamination of mass casualties--re-evaluating existing dogma.

The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response. This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response. Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.

Decontamination↗

Determination of cadmium in whole blood and urine electrothermal atomic absorption spectrometry using palladium-based modifiers and in situ decontamination.

The determination of Cd in whole blood and urine by electrothermal atomic absorption spectrometry using Pd-based modifiers and in situ decontamination was studied. The performance of Pd, Pd + NH4NO3, and Pd + Mg(NO3)2 as modifiers were compared with respect to maximum pyrolysis and atomization temperatures, background attenuation, linear calibration range and matrix interference. Samples were diluted (1 + 4) with 0.1% Triton X-100 (blood) or 0.2% HNO3 (urine), and introduced onto the graphite tube platform already containing the in situ dried and decontaminated modifier. The influence of modifier volume and concentration, as well as that of the dilution ratio was investigated. The proposed procedure involves the use of Pd(NO3)2 + (Mg(NO3)2 as modifier, a pyrolysis temperature of 700 degree C and an in situ decontamination step of 1200 degrees C. The atomization temperature was 1700 degrees C. The detection limit (n = 10, k = 3) was 0.22 micrograms l-1 for both samples. Typical relative standard deviation values (n = 3) were below 3%. Using matrix-matched standards, good agreement was observed between experimental and reference values in the analysis of certified reference materials. Interlaboratory comparison data have confirmed the validity of the proposed analytical procedure.

Cadmium↗

A prospective study of acute, unintentional, pediatric superwarfarin ingestions managed without decontamination.

STUDY OBJECTIVE: We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K. METHODS: We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who received gastrointestinal decontamination or prophylactic vitamin K were excluded. Forty-eight- to 96-hour prothrombin time or international normalized ratio (INR) blood tests were recommended, and telephone contact was attempted at least 3 days after ingestion. RESULTS: A total of 595 consecutive patients were enrolled during the 16-month study period. Fifty patients were excluded: 8 who were known to have ingested 1 pellet or less; 25 who received activated charcoal; 15 who were treated with induced emesis; and 2 who received prophylactic vitamin K. The resulting study group contained 545 patients. Eighty-two patients were lost to follow-up. Follow-up was obtained for 463 patients, including 222 by telephone contact alone, 62 by 48- to 96-hour INR, and 179 by both methods. None of the patients had clinically important coagulopathy. Two patients had an INR of 1.5 or greater (1.5 and 1.8) without symptoms. Single nosebleeds were reported in another 2 patients with normal 48-hour INRs. Another child had a small amount of blood crusted in the nose with no other symptoms and no laboratory work available. One child with a normal 48-hour INR had blood-streaked stools that were thought to be caused by an anal fissure. CONCLUSION: Children with acute unintentional superwarfarin ingestions of less than 1 box may be managed without gastric decontamination or prophylactic vitamin K. Laboratory testing for coagulopathy should be reserved for cases involving clinically evident bleeding abnormalities.

4-Hydroxycoumarins↗

Perspectives on mycotoxin decontamination procedures.

Unquestionably, prevention is the best method for controlling mycotoxin contamination. Should the contamination occur, however, the hazard associated with the toxin must be removed if the product is to be used for food or feed purposes. Decontamination procedures currently used are based on (a) physical, chemical, or biological removal, or (c) physical or chemical inactivation. Ammoniation of corn, peanuts, cottonseed, and meals to alter the toxic and carcinogenic effects of aflatoxin contamination has been the subject of intense research effort by scientists in various government agencies and universities worldwide. Engineers have devised workable systems of treatment of whole seeds, kernels, or meals; chemists have identified and characterized products formed from the reaction of aflatoxin B1 with ammonia with and without a meal matrix; biochemists have studied the biological effects of these compounds in model systems; and nutritionists have studied animal responses to rations containing ammoniated or non-ammoniated components. This review describes these studies as well as other potentially useful decontamination processes. The results of aflatoxin/ammonia decontamination research demonstrate the efficiency and safety of ammoniation as a practical solution to aflatoxin detoxification in foods and animal feeds.

Aflatoxins↗

Distribution of ammonia/aflatoxin reaction products in corn following exposure to ammonia decontamination procedure.

The distribution of aflatoxin decontamination reaction products in corn following ammonia decontamination treatment was determined. The parameters of the ammoniation procedure used to decontaminate aflatoxin contaminated corn were 2% NH3, 16% moisture, 55 psi, 40-45 degrees C, and 60 min duration. Uniformly ring-labelled 14C-aflatoxin B1 was added to corn (1.0 microCi/kg) containing 7500 micrograms naturally-incurred aflatoxin B1 (AFB1)/kg. Aflatoxin levels were reduced by ca 93% after ammonia treatment. Distribution of radiolabelled AFB1 was used to follow the modification of AFB1 and the ammonia/aflatoxin reaction products were separated and isolated through a series of chemical extraction/partition procedures. Samples of the ammoniated product were fractionated through sequential extraction with methylene chloride and methanol, then either treated with acetic acid and sodium hydroxide or exposed to proteolytic enzyme digestion followed by methylene chloride extraction. Approximately 88% of the added radioactivity was detected in the corn after treatment (i.e. 12% of aflatoxin reaction products were volatile), ca 20% was extracted with methylene chloride and ca 13% was extracted with methanol. Treatment with acid and base released 18.8% of the added radioactivity. Similar amounts (19.1%) of aflatoxin-related compounds were liberated after enzymatic digestion with Pronase E. The remaining corn matrix after acid-base treatment or Pronase digestion contained ca 37.0% of the original radioactivity. A fluorescent spot on the TLC plate represented 6.1% of the CH2Cl2-extractable compounds and contained a compound which reacts chromatographically similarly to AFB2a.

Aflatoxins↗

[Study of the metal precipitation from decontamination leachates of municipal wastes fly ash incinerators].

This research work focuses on the development of a new process for the decontamination of municipal wastes incinerators fly ashes. The objective of this study was to evaluate different total and selective precipitation methods for metals removal from ash decontamination leachates. The tested options include 1) use of hydrated lime and caustic soda for selective (pH 5.0) and total (pH 8.5) metal precipitation; 2) addition of different chemicals (H3PO4, Na2S and FeCl3) in a pH range from 6.0 to 9.0. Fly ash decontamination assays using alkaline and acid washing steps were initially performed using optimal conditions previously established. Treated fly ashes respected the standards based on the TCLP leaching test for all studied metals and SPLP. Total metal precipitation tests carried out at pH 8.5 achieve removal yields for all metals > or = 90% using hydrated lime and > or = 83% using caustic soda. Selective precipitation tests alone at pH 5.0 show removal yields > or = 97% for Cr and between 75 and 87% for Al and Pb. Moreover, assays carried out using a stoechiometric addition of Na2S have allowed the separation of Cd (> or = 99%) and Zn (> or = 71%) as metal sulphides (CdS and ZnS). From an economical point of view, the most interesting option seems to be the leachates neutralization at pH 7.0 using Ca(OH)2 combined with the reuse of the treated leachates in the fly ash leaching steps. Metal precipitation cost at pH 7.0 has been estimated to be 22.7 CAN dollars tct-1 using Ca(OH)2, and 26.7 CAN dollars tct-1 using NaOH.

Carbon↗

Decontamination techniques of pathogen bacteria in meat and poultry.

Means of controlling or even improving the safety of food products is to decontaminate the carcasses or products during or at the end of the production line. The decontamination of meat and poultry can help to reduce human foodborne infections. However, process hygiene to prevent contamination should never be neglected. Some techniques of decontaminating raw meat and poultry meat products are discussed in this review.

Animals↗

Diphoterine for emergent decontamination of skin/eye chemical splashes: 24 cases.

Chemical skin/eye splashes can cause burns. Standard references recommend decontamination with water. Diphoterine, a polyvalent, hypertonic, amphoteric, chelating solution is an alternative. Occupational medical records of 24 workers in a German metallurgy firm from 1994 to 1998 were reviewed. There were 11 acid eye splashes, 8 acid skin splashes, 4 base eye splashes, and 1 base skin splash. Following Diphoterine decontamination, no burns developed and there were no requirements for burn treatment or sequelae. Three workers had 1 lost workday each. Diphoterine decontamination successfully prevented skin/eye burns in this group of metallurgy workers.

Accidents, Occupational↗