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      In Vitro Efficacy of the Ankaferd Galenic Hemostatic Extract as a Germicidal Agent

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          Abstract

          Background:

          Hydatid cysts are encountered frequently in regions endemic with livestock. The basic treatment for a hydatid cyst is total surgical removal of the cyst and its inner contents. Hypertonic NaCl or diluted betadine solution are used as germicidal agents for most hydatid surgeries. However, the germicidal efficacy of the Ankaferd Blood Stopper® (ABS) has not been investigated. Thus, we compared the efficacy of ABS for hydatid cysts with that of other germicidal agents.

          Methods:

          Lung and liver tissues containing hydatid cyst liquid were collected from slaughterhouses. Six samples of each cyst were randomly allocated into different groups as follows: 20% hypertonic NaCl, betadine solution, ABS, 20% liquefied Andazole solution, 0.1% eosin, and distilled water. All groups were examined microscopically at 5, 10, and 15 min after treatment began to determine protoscolece viability rates.

          Results:

          The most efficacious germicidal agent at 5 min was ABS, and betadine and hypertonic NaCl had similar efficacies. Betadine, ABS, and hypertonic NaCl showed similar efficacies at 15 min.

          Conclusion:

          ABS was an effective germicidal agent to treat hydatid cysts.

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          Most cited references7

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          Scolicidal Agents in Hydatid Cyst Surgery

          H. Besim, K. Karayalçin, O. Hamamci … (1998)
          Injecting scolicidal solutions into the hydatid cyst and packing the operative field with sponges soaked in scolicidal agents have been used to avoid dissemination of the parasite during surgery. In the first part of this invitro study, we tried to determine the scolicidal property of various agents in different concentrations and exposure times. In the second part, we tested whether sponges soaked in different type and concentrations of scolicidal agents have any role beyond being a mechanical barrier. 20% saline, 3% hydrogen peroxide, 1.5% cetrimide-0.15% chlorhexidine (10% Savlon®), 95% ethyl alcohol, 10% polyvinylpirrolidone-iodine (Betadine®) and their further dilutions were used in this study. Protoscoleces were obtained from the cyst containing livers of the sheep and viability was determined with dye-uptake (0.1% Eosin) and flame cell activity. Savlon® was found to be the least concentration dependent scolicidal agent among those studied. Scoleces sprayed on sponges soaked in 20% saline, 95% ethyl alcohol, Betadine® and 3% hydrogen peroxide were killed after 15 minutes. 3% and 10% saline and normal saline were ineffective. Sponges work not only as a mechanical barrier but also as a chemical one if the agent is chosen correctly. In purely cystic hydatid liver disease, the risk of dissemination of the cyst contents can be avoided by injection of a potent scolicidal agent such as Savlon®.
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            Use of PAIR in human cystic echinococcosis.

            Carlo Filice, Enrico Brunetti (1997)
            The authors report their experience with ultrasound (US)-guided percutaneous treatment of hydatid abdominal cysts (mainly hepatic). From November 1987 to January 1996 in Italy and in Kenya 231 cysts in 163 patients were treated with a technique called PAIR (puncture, aspiration, injection, re-aspiration), using 95% ethanol as a scolecide agent according to a routine protocol. In Kakuma, Turkana (Kenya) 141 cysts in 85 patients were treated with a simplified protocol and a portable US machine. No anaphylactic shock or peritoneal dissemination was observed. One failure was observed due to the proximity of the parasitic cyst to the gallbladder, resulting in a fistula between the two cavities; this complication was resolved by surgery. A few minor complications were observed. In all the other cases detachment of the germinal membrane and subsequent reduction in size was observed, with a more or less complete solidification of the cyst and reduction of serology titers. Only one cyst recurred after 4 years and was treated again by PAIR. Long-term results indicate that in type I, II and III cysts, according to the Gharbi classification, PAIR is a first-choice method for treatment of liver hydatid cysts, especially in developing countries.
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              Hypertonic saline in hydatid disease.

              C. Kayaalp, C. Aydin, V Kirimlioglu … (2001)
              The objective of this study was to determine the scolicidal effects of saline in different concentrations using different exposure times and to examine whether hypertonic saline can be used to irrigate the abdomen when there is a free intraperitoneal perforation of hydatid disease. Various concentrations of saline solutions (0.09%, 3.0%, 6.5%, 10%, 15%, 20%, 25%, 30%) were added to concentrated echinococcus granulosus sediments for the following times: 1, 2, 3, 4, 5, 10, 15, 30, 45, and 60 minutes. Normal (0.09%), 3.0%, and 6.5% saline resulted in high viability ratios after 60 minutes' exposure. Complete lethality for 10%, 15%, 20%, 25%, and 30% saline occurred at the end of 75, 10, 6, 3, and 3 minutes, respectively. During the second part of the study, 20 Sprague-Dawley rats were used for abdominal saline irrigation in four groups: 30% NaCl for 3 minutes; 20% NaCl for 6 minutes; intravenous isotonic dextrose water and furosemide plus 30% NaCl irrigation for 3 minutes; the same prophylactic therapy plus 20% NaCl irrigation for 6 minutes. Sodium and chloride values rose significantly (20-30%) shortly after hypertonic saline irrigation in each group (p < 0.01). Support with isotonic dextrose and furosemide before irrigation did not have any beneficial effect on biochemical values or mortality. The 24- and 48-hour mortality rates were 70% and 90%, respectively. These studies illustrate that the scolicidal effect of hypertonic saline is limited in low concentrations, but an increase in the concentration can augment its adverse effects. Peritoneal irrigation with hypertonic saline should be avoided for intraabdominal perforated hydatid disease. Therefore, we concluded that hypertonic saline is not a good scolicidal agent to prevent recurrence of hydatid disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Parasitol
                Journal ID (iso-abbrev): Iran J Parasitol
                Journal ID (publisher-id): IJPA
                Journal ID (pmc): IJPA
                Title: Iranian Journal of Parasitology
                Publisher: Tehran University of Medical Sciences
                ISSN (Print): 1735-7020
                ISSN (Electronic): 2008-238X
                Publication date (Print): Jul-Sep 2016
                Volume: 11
                Issue: 3
                Pages: 406-410
                Affiliations
                [1. ] Department of Thoracic Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
                [2. ] Department of Infectious Diseases, Faculty of Medicine, Bozok University, Yozgat, Turkey
                [3. ] Division of Public Health Affairs, Ministry of Health, Ankara, Turkey
                [4. ] Department of General Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
                [5. ] Department of Cardiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
                [6. ] Department of Chest Diseases, Faculty of Medicine, Bozok University, Yozgat, Turkey
                [7. ] Department of Neurosurgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
                [8. ] Department of Pediatric Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
                Author notes
                [* ] Correspondence Email: drbaymet@ 123456hotmail.com
                Article
                Publisher ID: ijpa-11-406
                PMC ID: 5256059
                PubMed ID: 28127348
                SO-VID: 9706fe0e-2561-4f75-a784-64694fe6f584
                Copyright © Copyright© Iranian Society of Parasitology & Tehran University of Medical Sciences
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                Date received : 13 November 2015
                Date accepted : 08 February 2016
                Categories
                Subject: Short Communication

                ScienceOpen disciplines: Parasitology
                Keywords: hydatid cyst,germicidal agent,ankaferd blood stopper
                Data availability:
                ScienceOpen disciplines: Parasitology
                Keywords: hydatid cyst, germicidal agent, ankaferd blood stopper

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