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1
Jha, Shilpa, Wasim S. Khan i Nashat A. Siddiqui. "Mammalian Bite Injuries to the Hand and Their Management". Open Orthopaedics Journal 8, nr 1 (27.06.2014): 194–98. http://dx.doi.org/10.2174/1874325001408010194.
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Bite wounds are a common form of hand injury with the potential to lead to severe local and systemic sequelae and permanent functional impairment. Mammalian bite wounds may be caused by a variety of animal class and species; injuries resulting from dogs, cats and humans are the most widely discussed and reported in the literature. Bite wounds may be contaminated with aggressive pathogens and the anatomical vulnerability of structures within the hand means that without early recognition and treatment with irrigation and antibiotics, alongside a low index of suspicion for deep structural involvement requiring formal surgical exploration and washout, the consequences of such injuries can be disastrous. We review the literature and discuss the epidemiology, pathophysiology and microbiology relating to these injuries, as well as clinical aspects including signs, symptoms, and management.
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Zaporozhan, S. Y., D. B. Fira i O. V. Pokryshko. "ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES". International Journal of Medicine and Medical Research 8, nr 1 (5.09.2022): 18–24. http://dx.doi.org/10.11603/ijmmr.2413-6077.2022.1.13098.
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Background. Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns. Objective. The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics. Methods. The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007. Results. The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant. Conclusions. Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.
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Langford, Jane H., Phillip Artemi i Shalom I. Benrimoj. "Topical Antimicrobial Prophylaxis in Minor Wounds". Annals of Pharmacotherapy 31, nr 5 (maj 1997): 559–63. http://dx.doi.org/10.1177/106002809703100506.
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OBJECTIVE: To evaluate the ability of a novel topical antimicrobial gel containing cetrimide, bacitracin, and polymyxin B sulfate to prevent infections of minor wounds. DESIGN: A clinical trial compared the test preparation with placebo and a povidone iodine antiseptic cream. SETTING: Five primary schools in Sydney, Australia, participated in the study over a 6-week spring/summer school term. SUBJECTS: Children aged 5–12 years with parental consent were eligible for study participation. Accidental injuries occurring at school were treated in a standardized manner by nurses at each site. OUTCOME MEASURES: Wounds were evaluated by the medical practitioner after 3 days of topical treatment. The clinical outcome was classified as resolution or suspected infection. If a clinical infection was suspected, the injury was swabbed for microbiologic evaluation. Growth of a dominant microorganism was classified as a microbiologic infection. RESULTS: Of the 177 injuries treated, there were nine clinical infections. A comparison of these showed a significant difference among treatment groups (p < 0.05). This difference was associated with the test preparation and placebo; the test preparation reduced the incidence of clinical infection from 12.5% to 1.6% (p < 0.05; 95% CI, 0.011 to 0.207). A comparison of microbiologic infections showed no significant differences among treatment groups (p > 0.05). CONCLUSIONS: The novel gel preparation containing cetrimide, bacitracin, and polymyxin B sulfate showed therapeutic action and reduced the incidence of clinical infections in minor accidental wounds. It may be a suitable product for first aid prophylaxis.
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Rodrigues, Adrian E., David Dolivo, Yingxing Li, Chun Hou, Lauren Sun, Thomas A. Mustoe, Seok Jong Hong i Robert D. Galiano. "Thermal Burn Wounds Produce Greater Scars Compared to Similarly Sized Excisional Wounds And Topical Amiloride Applied to Burn-Induced Scars Shows Scar Reduction". SKIN The Journal of Cutaneous Medicine 6, nr 5 (12.09.2022): 374–83. http://dx.doi.org/10.25251/skin.6.5.3.
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Background: Victims of severe traumatic injuries such as large surface area lacerations and thermal burns require substantial medical care that primarily promotes healing. And although this care is essential, there is a lack of pharmacological treatments that reduce the resulting scars, consequently leaving many traumatic victims with profusely disfigured skin.
Methods: A rabbit-ear injury model was used to compare scar progression in adjacently paired contact thermal burns (n=24) and excisional wounds (n=16). Once that model revealed significant differences in scar hypertrophy between these two types of injuries, a succeeding study involved solely inducing burns, with the resulting wounds undergoing scar elevation index (SEI) and gene expression analysis after unilateral topical treatment with either amiloride (n=12), celecoxib (n=11) or contralateral vehicle control (n=10 for each of the two control groups).
Results: In the initial burn and excisional wound comparison study, thermal burns showed significantly larger scars, both in scar height measured at four timepoints (P<0.0001, <0.01, <0.05, and <0.05) and histologically by analyzing the SEI (P<0.05). In the succeeding project, burn-induced scars treated with amiloride also demonstrated a significantly reduced histological SEI (P<0.05) compared to scars receiving vehicle control. However, relative PTGS2, ACTA2 and COL1A1 expression was not significantly different in scar tissues treated with amiloride compared to those receiving vehicle control. Also, no significant differences in SEI were determined in scars treated with celecoxib compared to vehicle control
Conclusions: Contact thermal burn injuries create profusive hypertrophic scars compared to similarly sized excisional wounds. Topical application of amiloride to burn-induced scars reduce scar formation, yet this finding necessitates further studies to comprehend the mechanism behind its scar-reducing effect.
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Shaprynskyi, V. O., A. V. Verba, Y. V. Shaprynskyi, O. O. Fomin i N. S. Fomina. "SPECIFIC ASPECTS IN TREATMENT OF SUPPURATIVE-INFLAMMATORY COMPLICATIONS IN GUNSHOT WOUNDS OF EXTREMITIES". Kharkiv Surgical School, nr 2 (20.06.2021): 121–27. http://dx.doi.org/10.37699/2308-7005.2.2021.22.
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Summary. The aim of the study was to present an argument for treatment algorithm of patients with extremity gunshot injuries complicated by suppurative inflammation.
Materials and research methods. Examination and treatment of 163 patients with gunshot wounds of the extremities were performed. All the wounded were divided into 3 study groups. The patients of group 1 underwent conventional treatment of gunshot wounds. In group 2, negative pressure wound therapy was used. Wounded patients of group 3 received vacuum-assisted therapy supplemented by the proposed scheme of counter-drainage and flow-through flushing irrigation of wounds with antiseptic solutions of 0.02 % decamethoxine and 3 % hydrogen peroxide. Bacteriological study of wound exudate was carried out, and sensitivity of microorganisms to antibiotics was determined.
Results and its discussion. Wound microbiology analysis in victims of blast and mine-blast injuries demonstrated predominance of gram-negative bacteria in wound microbiocenosis — Acinetobacter spp. (53 % of cases) and Pseudomonas spp. (15 % of cases). Gram-positive cocci were isolated in 22.2 % of cases. Sensitivity study of nonfermentative gram-negative rods demonstrated them to have high level of resistance to most antibacterial agents. All strains of Acinetobacter and Pseudomonas spp. were sensitive to polymyxin B and colistin but resistant to inhibitor-protected and -unprotected amino penicillin.
Beneficial effect of vacuum therapy in patients of groups 2 and 3 was evidenced by significantly reduced time of wound healing and hospital stay. The use of suggested mixture of antiseptics resulted in decrease of inflammation in 94.45 % and 88.89 % of patients in groups 3 and 2, respectively. Besides, in group 3, duration of hydration phase in wound healing process decreased to 5.7 days. The period of complete wound healing was shorter by 2.5 days, and hospital stay decreased from 14.97 to 10.8 days.
Conclusions. Thus, predominance of gram-negative microorganisms in gunshot wounds as well as their high resistance to antibiotics should be considered when undertaking empirical antibiotic therapy in wounded patients. The proposed treatment algorithm involving negative pressure wound therapy supplemented with counter-drainage and flow-through flushing irrigation with a mixture of suggested antiseptics proved to be highly efficient in patients with extremity gunshot injuries complicated by suppurative inflammation.
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Kontogiorgi, Marina, Ioannis Floros, Apostolos Koroneos, Chrysanthi Vamvouka, Olga Paniara, Charis Roussos i Christina Routsi. "Fatal post-traumatic zygomycosis in an immunocompetent young patient". Journal of Medical Microbiology 56, nr 9 (1.09.2007): 1243–45. http://dx.doi.org/10.1099/jmm.0.46993-0.
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Zygomycosis, a relatively uncommon infection, usually occurs among immunocompromised individuals. It has been reported only rarely in trauma patients. A fatal case is reported of pulmonary and rapidly progressive cutaneous zygomycosis in a young, otherwise healthy farmer, with multiple bone fractures, wounds and soft tissue injuries after an accident with an agricultural machine in the field. Rhizopus spp. was isolated from both cultures of bronchial washings and wound samples. The diagnosis was confirmed by histopathological examination of tissue specimens from a large wound. Despite systemic antifungal therapy and surgical debridement, the patient's condition deteriorated and he died from refractory septic shock.
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SAHLI, Z. T., A. R. BIZRI i G. S. ABU-SITTAH. "Microbiology and risk factors associated with war-related wound infections in the Middle East". Epidemiology and Infection 144, nr 13 (2.03.2016): 2848–57. http://dx.doi.org/10.1017/s0950268816000431.
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SUMMARYThe Middle East region is plagued with repeated armed conflicts that affect both civilians and soldiers. Injuries sustained during war are common and frequently associated with multiple life-threatening complications. Wound infections are major consequences of these war injuries. The microbiology of war-related wound infections is variable with predominance of Gram-negative bacteria in later stages. The emergence of antimicrobial resistance among isolates affecting war-related wound injuries is a serious problem with major regional and global implications. Factors responsible for the increase in multidrug-resistant pathogens include timing and type of surgical management, wide use of antimicrobial drugs, and the presence of metallic or organic fragments in the wound. Nosocomial transmission is the most important factor in the spread of multidrug-resistant pathogens. Wound management of war-related injuries merits a multidisciplinary approach. This review aims to describe the microbiology of war-related wound infections and factors affecting their incidence from conflict areas in Iraq, Syria, Israel, and Lebanon.
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Fan, Youfen, Yanyan Pan, Cui Chen, Shengyong Cui, Jiliang Li, Guoying Jin, Neng Huang i Sida Xu. "Use of Composite Acellular Dermal Matrix-Ultrathin Split-Thickness Skin in Hand Hot-Crush Injuries: A One-Step Grafting Procedure". BioMed Research International 2022 (21.07.2022): 1–12. http://dx.doi.org/10.1155/2022/1569084.
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Background. Hot-crush injuries to the hands can be devastating, and early debridement and coverage with skin autograft remains the golden standard of wound treatment. However, this type of treatment is not feasible or unlikely to succeed due to limited donor sites and wound characteristics of hot-crush injuries on hands. Thus, the composite grafting of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) as a novel alternative method has been attempted. In this series, the results are presented to demonstrate the feasibility and effectiveness of the use of one-stage procedure for early reconstruction in hand hot-crush injuries. Methods. All consecutive patients with hand hot-crush injuries, who underwent one-stage procedure of ADM and ultrathin STSG for soft tissue coverage at our institution from December 2018 to November 2019, were retrospectively analyzed. Wound dressings were opened on 7 days after operation to examine graft survival and complications. Patients were followed up for at least 9 months to evaluate their hand profiles. Results. Samples of 14 patients with a total of 23 wounds were involved in the study. Thirteen of the 23 third–fourth-degree wounds had varying degrees of tendon exposure. On 7 days postoperation, the composite grafts survived in 12 patients with minimal focal graft losses and liquefaction and necrosis in 2 patients, which achieved successful healing following new coverage of ultrathin STSG. All the wounds healed with hospital stays ranging from 9 days to 32 days (median: 24.5 days). At the final follow-up (from 9 months to 20 months), all patients achieved excellent or good total active motion grade and good scar quality (Vancouver scar scale scored 1–3) with no revision surgery. Conclusions. One-stage composite grafting of ADM and ultrathin STSG is a reliable alternative for early reconstruction in hand hot-crush injuries, which delivers good functional outcomes and a good cosmetic appearance.
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Frank, Erik T., Marten Wehrhahn i K. Eduard Linsenmair. "Wound treatment and selective help in a termite-hunting ant". Proceedings of the Royal Society B: Biological Sciences 285, nr 1872 (14.02.2018): 20172457. http://dx.doi.org/10.1098/rspb.2017.2457.
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Open wounds are a major health risk in animals, with species prone to injuries likely developing means to reduce these risks. We therefore analysed the behavioural response towards open wounds on the social and individual level in the termite group-hunting ant Megaponera analis . During termite raids, some ants get injured by termite soldiers (biting off extremities), after the fight injured ants get carried back to the nest by nest-mates. We observed treatment of the injury by nest-mates inside the nest through intense allogrooming at the wound. Lack of treatment increased mortality from 10% to 80% within 24 h, most likely due to infections. Wound clotting occurred extraordinarily fast in untreated injured individuals, within 10 min. Furthermore, heavily injured ants (loss of five extremities) were not rescued or treated; this was regulated not by the helper but by the unresponsiveness of the injured ant. Interestingly, lightly injured ants behaved ‘more injured’ near nest-mates. We show organized social wound treatment in insects through a multifaceted help system focused on injured individuals. This was not only limited to selective rescuing of lightly injured individuals by carrying them back (thus reducing predation risk), but, moreover, included a differentiated treatment inside the nest.
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Warkentien, Tyler E., Faraz Shaikh, Amy C. Weintrob, Carlos J. Rodriguez, Clinton K. Murray, Bradley A. Lloyd, Anuradha Ganesan, Deepak Aggarwal, M. Leigh Carson i David R. Tribble. "Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections". Journal of Clinical Microbiology 53, nr 7 (13.05.2015): 2262–70. http://dx.doi.org/10.1128/jcm.00835-15.
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Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively;P< 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds withMucoralesgrowth than for wounds with non-Mucoralesgrowth (median, 17 days versus 13 days;P< 0.01). When wounds withMucoralesandAspergillusspp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: orderMucorales,Aspergillusspp., andFusariumspp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds withMucoralesgrowth.
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Okamoto, Shigefumi, Kazuhiro Ogai, Kanae Mukai i Junko Sugama. "Association of Skin Microbiome with the Onset and Recurrence of Pressure Injury in Bedridden Elderly People". Microorganisms 9, nr 8 (27.07.2021): 1603. http://dx.doi.org/10.3390/microorganisms9081603.
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Pressure injuries have been identified as one of the main health hazards among bedridden elderly people. Bedridden elderly people often stay in the same position for a long time, because they cannot switch positions; thus, the blood flow in the part of the body that is being compressed between the bed and their own weight is continuously blocked. As a result, redness and ulcers occur due to lacking oxygen and nutrients in the skin tissues, and these sites are often infected with microorganisms and, thus, become suppurative wounds, a condition commonly determined as pressure injuries. If left untreated, the pressure injury will recur with microbial infections, often resulting in cellulitis, osteomyelitis, and sepsis. The skin microbiome, in which many types of bacteria coexist, is formed on the skin surface. However, it remains unclear what characteristic of the skin microbiome among the bedridden elderly constitutes the development and severity of pressure injuries and the development of post-pressure injury infections. Thus, in this review article, we outlined the changes in the skin microbiome among the bedridden elderly people and their potential involvement in the onset and recurrence of pressure injuries.
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Ameling, Jessica, M. Todd Greene, Martha Quinn i Jennifer Meddings. "Pilot Testing a Bedside Patient Safety Display to Increase Provider Awareness of the ‘Hidden Hazards’ of Catheters and Wounds". Infection Control & Hospital Epidemiology 41, S1 (październik 2020): s351—s352. http://dx.doi.org/10.1017/ice.2020.968.
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Background: Urinary catheters, vascular catheters, and wounds, such as pressure injuries are often hidden from view under gowns and sheets (ie, out of sight, out of mind), contributing to prolonged catheter use, infections, delayed interventions, and diagnostic errors for symptoms (eg, fever or delirium) related to catheters and wounds. We developed and pilot tested a digital bedside Patient Safety Display of catheter and wound information to improve awareness by rounding providers (ie, physicians and advanced practice providers, APPs). Methods: The display development was informed by clinical observations of provider rounds and nurse handoffs, interviews, and iterative prototype testing with clinicians in simulated cases using catheterized mannequins with wounds. The display reports the presence and duration of urinary and vascular catheter use, urinary catheter indication, and wound presence and severity, from real-time mandatory nurse documentation in the electronic medical record (Fig. 1). We conducted a pilot study in a tertiary-care medical-surgical step-down unit with 20 private rooms, including a preintervention period and a postintervention period including 10 rooms without the display (control rooms) and 10 rooms with the display (intervention rooms). We surveyed individual providers directly after rounds to assess their awareness of their patients’ catheters and wounds compared to medical record documentation. We also assessed display utility and usability from postintervention clinician interviews and we identified major themes using an adapted grounded theory approach. Results: In total, 787 surveys were completed: 681 medicine service with 89% response rate, 106 surgery service with 47% response rate; 363 preintervention surveys, and 424 postintervention surveys. The surveys involved 176 unique patients and 47 unique providers. Among all 787 patient encounters, 156 (19.8%) had a transurethral indwelling urinary catheter (Foley), 314 (39.9%) had a central venous catheter (including PICCs), and 247 (31.4%) had at least 1 pressure injury. Figure 2 summarizes provider awareness of catheters and pressure injuries when present as assessed for patients in the preintervention and postintervention periods. Moreover, 13 clinician postintervention interviews yielded preliminary themes regarding the display’s benefits and limitations (Fig. 3). Conclusions: In this pilot study of a novel Patient Safety Display, although provider awareness of Foley catheters, CVCs, and pressure injuries appeared higher for patients in the intervention rooms compared to awareness as measured in the preintervention rooms and/or postintervention control rooms, most of these comparisons did not meet statistical significance. Clinicians varied widely in their personal assessments of the display as a useful tool for improving awareness and prompting discussion about catheters and wounds.Funding: This work was funded by the Agency for Healthcare Research and Quality (AHRQ) grant P30HS024385. Dr. Meddings’ effort was initially partially funded by concurrent support from AHRQ (K08 HS19767).Disclosures: Dr. Meddings has reported receiving honoraria for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection. The remaining authors report no conflicts of interest.
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Ostroushko, Anton, Аlexandr Glukhov, Alexandr Andreev, Vladimir Vecherkin, Viktoriya Shishkina, Anastasiya Laptiyova, Sergey Lobas i in. "Flow Sorption Debridement of Aseptic and Purulent Soft Tissue Wounds". International Journal of Biomedicine 12, nr 1 (10.03.2022): 49–54. http://dx.doi.org/10.21103/article12(1)_oa6.
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Background: Treatment of isolated and combined open soft tissue wounds remains relevant due to the growth of severe injuries, comorbid pathologies, and immunosuppressive conditions, along with a decrease in antibiotic sensitivity of microorganisms. The aim of this study was to compare the effectiveness of the jet oxygen-sorption treatment (JOST) and flow sorption debridement techniques (FSDT) in the therapy of experimental soft tissue wounds. Methods and Results: The effectiveness of the JOST and FSDT was compared in 2 series of experiments on 288 laboratory Wistar rats with simulated soft tissue wounds. Series 1 (S1) involved 144 animals divided into 2 control groups (CG) and 2 experimental groups (EG); the effectiveness of the developed techniques for the aseptic wound treatment was studied in these groups of animals. Series 2 (S2) involved 144 animals divided into 2 CGs and 2 EGs; in S2, purulent soft tissue wounds were studied. The effectiveness of the developed techniques in the complex treatment of experimental wounds was assessed immediately, on Days 1, 3, 5, 7 and 10 after simulating the pathological process. The assessment included the animals’ condition, the dynamics of the course of reparative processes (local symptoms of inflammation; granulation; epithelialization of wounds; and size and dynamics of the area of the defect), and histological research methods. The use of the JOST has practically no benefits in aseptic wound treatment, compared to FSDT. The use of the JOST and FSDT contributed to a significant acceleration of healing process in aseptic wounds that was expressed in the decreased local inflammatory reactions, higher activity of metabolic processes based on the dynamics of RNA and SH-groups. The most pronounced positive dynamics in the treatment of purulent wounds was observed when applying FSDT. Compared with the findings obtained in CG1-S2, FSDT contributed to a reduction in necrolysis termination by 25.7%, fibrinolysis - by 25.5%, granulation - by 20.0%, epithelization - by 18.9%, wound discharge - by 27.8%. Conclusion: The developed technique of FSDT in the complex treatment of soft tissue wounds provides the most pronounced positive dynamics, accelerates reparative tissue processes, and reduces the duration of wound cleansing and healing for both aseptic and purulent wounds.
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Bohrani Sefidan, Bahram, Seyed Ali Tabatabaei, Mohammad Soleimani, Aliasghar Ahmadraji, Mansoor Shahriari, Mostafa Daraby, Amin Dehghani Sanij, Ali Mehrakizadeh, Bahareh Ramezani i Kasra Cheraqpour. "Epidemiological characteristics and prognostic factors of post-traumatic endophthalmitis". Journal of International Medical Research 50, nr 2 (luty 2022): 030006052110707. http://dx.doi.org/10.1177/03000605211070754.
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Objective To examine the prognostic factors and features of post-traumatic endophthalmitis. Methods This retrospective study enrolled adult patients (>18 years old) diagnosed with post-traumatic endophthalmitis. Their medical records were reviewed and the patient demographic characteristics, features of injury, management, outcomes and microbiology data were analysed. Results A total of 131 eyes from 131 patients were enrolled. Post-traumatic endophthalmitis was more common in male patients (122 of 131 patients: 93.1%), in those aged 30–44 years (51 of 131 patients: 38.9%), in those injured with a metallic object (86 of 131 patients; 65.6%), in those with a penetrating injury (90 of 131 patients; 68.7%) and those that were injured at work (106 of 131 patients; 80.9%). The mean ± SD time of presentation to the hospital and developing endophthalmitis was 40.60 ± 19.32 h and 5.19 ± 2.55 days, respectively. Of the cultures, 84 of 131 (64.1%) were negative and 22 of 131 (16.8%) were positive for Staphylococcus species. Patients with delayed presentation, an intraocular foreign body, traumatic cataract, retinal detachment, larger wounds, positive smears and cultures and work-related injuries had worse outcomes. Conclusion Immediate presentation to an ophthalmic centre and timely diagnosis and intervention may lead to better outcomes.
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Pavlićević, Goran. "Risk factors for postoperative infection after combat related head injuries". Neurohirurgija - The Serbian Journal of Neurosurgery 1, nr 1 (8.03.2022): 3–7. http://dx.doi.org/10.55005/sjns.v1i1.3.
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Introduction
The prevalence of penetrating head injuries (PBI) has increased during the latest wars making up to 37,4% of all injuries (1,2) Microbiology of modern war wounds is unique for each military conflict depending on the climatic and geographical features of the theater of combat (3,4).
Material and methods:
286 patients were operatively treated after penetrating combat injury in our institution between 1991-1999. Based on the inclusion criteria: combat-related cranial injury and absence of severe abdominal or chest combat injuries, as well as their ability to report for a follow-up exam led to the inclusion of 202 patients. Initial surgical treatment included removal of devitalized soft tissue and bone fragments with craniectomy, removal of devitalized brain tissue, easily accessible intracerebral bone and metal fragments and intracranial hemathoma. All patients received the same standardized postoperative care with triple antibiotics.
Results
Infection occurred in 36 patients (17,82%). In vast majority of the cases infection occurred in the form of brain abscess 31 (86.11%), in 4 cases as meningitis (11.1%) and in 1 case as osteomyelitis and epidural infection (2.78%). Retained metal and bone fragments and postoperative liquorrhea have significant influences on occurrence of postoperative infection.
Conclusion
Postoperative infection considerably increases long term functional outcome. Using advantages of minimally invasive surgical technique, neuronavigation or intraoperative imaging for removal of retained foreign bodies can reduce risk for postoperative infection with minimal risk of additional neurologic deficit. Autograft is preferable option for dural reconstruction in combat related head injuries.
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Tanner, Michael A., Christine L. Everett i Douglas C. Youvan. "Molecular Phylogenetic Evidence for Noninvasive Zoonotic Transmission of Staphylococcus intermedius from a Canine Pet to a Human". Journal of Clinical Microbiology 38, nr 4 (2000): 1628–31. http://dx.doi.org/10.1128/jcm.38.4.1628-1631.2000.
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rRNA-based molecular phylogenetic techniques were used to identify the bacterial species present in the ear fluid from a female patient with otitis externa. We report the identification ofStaphylococcus intermedius from the patient and a possible route of transmission. Analysis of 16S ribosomal DNA restriction fragment length polymorphisms indicated that the dominant species present was S. intermedius. A pet dog owned by the patient also was tested and found to harbor S. intermedius. In humans, the disease is rare and considered a zoonosis. Previously,S. intermedius has been associated with dog bite wounds, catheter-related injuries, and surgery. This study represents the first reported case of a noninvasive infection with S. intermedius.
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Spille, Johannes, Juliane Schulz, Dorothee Cäcilia Spille, Hendrik Naujokat, Henning Wieker, Jörg Wiltfang i Aydin Gülses. "Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center’s Experience". Antibiotics 10, nr 8 (18.08.2021): 998. http://dx.doi.org/10.3390/antibiotics10080998.
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The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.
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NAQVI, ZULFIQAR ALI, SALEEM A. KHARAL i QAMAR AZIZ. "BURN PATIENTS". Professional Medical Journal 18, nr 02 (10.06.2011): 300–305. http://dx.doi.org/10.29309/tpmj/2011.18.02.2088.
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Objectives: To study the micro flora in wounds of the burn patients from three tertiary care medical hospitals in Karachi. Introduction: In burn patient infections arise from multiple sources and infect burn wounds by a variety of micro-organisms. Gram negative bacterial infection results from translocation from colon, further more burn patients are infected by Hospital acquired bacteria by various invasive and non invasive procedures. Period: July 2002 to December 2002. Setting: This study was conducted at the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Study Design: Observational study. Material & Methods: A retrospective study of fifty five patients with burn wound infection was carried out at burn units of Civil Hospital Karachi, National Institute of Child health Karachi and Abbasi Shaheed Hospital, Karachi. Patients who received burn injuries with clinical signs and symptoms of infection were included in this study. Results: In the present study 46(29%) isolates of P. aeruginosa were recovered, in which most strains were MDR and their sensitivity against Imipenem was 38 (78%). The over all prevalence of the Oxidase negative Gram negative coli form bacteria was more than 70%, in which the most prevalent organism belongs to Proteus Spp;(27%) follows the Enterobacter Spp;.(15.5%). Conclusions: Bacteria belongs with family Enterobacteriacae were more prevalent i.e. >70% while P. aeruginosa was individually more prevalent than any member of family Enterobacteriacae and was most resistant to multiple antibiotics than any other bacteria. Imipenem was the most effective drug against all gram negative bacteria follows the 4th. generation Cephalosporin Cefepime.
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Pormohammad, Ali, Nadia K. Monych, Sougata Ghosh, Diana L. Turner i Raymond J. Turner. "Nanomaterials in Wound Healing and Infection Control". Antibiotics 10, nr 5 (21.04.2021): 473. http://dx.doi.org/10.3390/antibiotics10050473.
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Wounds continue to be a serious medical concern due to their increasing incidence from injuries, surgery, burns and chronic diseases such as diabetes. Delays in the healing process are influenced by infectious microbes, especially when they are in the biofilm form, which leads to a persistent infection. Biofilms are well known for their increased antibiotic resistance. Therefore, the development of novel wound dressing drug formulations and materials with combined antibacterial, antibiofilm and wound healing properties are required. Nanomaterials (NM) have unique properties due to their size and very large surface area that leads to a wide range of applications. Several NMs have antimicrobial activity combined with wound regeneration features thus give them promising applicability to a variety of wound types. The idea of NM-based antibiotics has been around for a decade at least and there are many recent reviews of the use of nanomaterials as antimicrobials. However, far less attention has been given to exploring if these NMs actually improve wound healing outcomes. In this review, we present an overview of different types of nanomaterials explored specifically for wound healing properties combined with infection control.
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English, Judith Fay Boylan. "Reported Hospital Needlestick Injuries in Relation to Knowledge/Skill, Design, and Management Problems". Infection Control & Hospital Epidemiology 13, nr 5 (maj 1992): 259–64. http://dx.doi.org/10.1086/646524.
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AbstractObjectives:To investigate reported needlestick injuries in hospital workers from an adult learner theory perspective: identifying safe needle device knowledge and practice, and flaws in needle designs and management practices surrounding such problems.Design:Exploratory descriptive study of reported needlestick injuries from hollow needled devices in a hospital. Injured healthcare workers were counseled via hospital protocol, then a survey was filled out containing no identifiers of individual or institution.Setting:Seventeen Metropolitan Washington, DC, area hospitals.Participants:All workers reporting needlestick injuries during February 1-28, 1990.Results:Seventy-two injuries were reported; there were no multiple injuries to any individual. Thirty-three (45.8%) were to registered nurses (RNs)-more than any other group of workers. Recapping accounted for a higher percentage than any other activity (10 sticks, 14.1%). Of workers incurring recapping injuries, 3 identified a knowledge of a one-handed spearing technique and did not practice it; 4 neither knew nor practiced it. Eighteen (25.0%) were to “down-stream” housekeepers and aides who did not use such devices in their practice. Disposable needle/syringes caused 49.3% of injuries; hypodermic needles on intravenous lines caused 16.9%. Of the needlesticks, 60.6% were after use and before disposal, 4.2% occurred as the worker was putting an item into a needlebox, and 9.9% occurred from needles protruding from inappropriate bags. Many injuries occurred in the first 2 hours of work after being off the previous day, on Sunday, and on MondayConclusions:Of nurses and medical technologists reporting knowledge of a spearing recapping technique, 97.3% suffered injury via other methods. This strongly suggests that knowledge leads to different action. Safer needled devices and needle-free systems would make a safer workplace. Further study is indicated to identify if and why the first two hours after returning to work on Sunday or Monday are risky for needlestick injuries. Management practices must ensure compliance to safe practice both by employees and related medical staff.
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Muhammad, S. T., M. Abdurrahman, D. O. Avazi, B. Usman, E. G. Emmanuel, M. H. Sulaiman, P. H. Mamman i in. "Management of Diffuse Necrotic Cutaneous Wound in a Dog". Sahel Journal of Veterinary Sciences 17, nr 2 (29.06.2020): 49–52. http://dx.doi.org/10.54058/saheljvs.v17i2.133.
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A one-year-old male Terrier dog weighing 22 kg was presented to the Ahmadu Bello University Veterinary Teaching Hospital (ABUVTH), Zaria, Nigeria, with complaints of sloughing of the skin and purulent discharges from an injured (sloughed) shoulder. Clinical examination revealed normal vital parameters, extensive necrotized skin on the dorsum extending from loin to the right shoulder and enlarged superficial lymph nodes. Blood and wound swab samples were evaluated in the clinical haematology and Microbiology Laboratories of the ABUVTH, respectively. The Pathology result showed leucocytosis due to neutrophilia and monocytosis. Staphylococcus aureus was isolated from the wound swab. The wound was managed by wet-to-dry bandaging technique using topical antiseptics (Para-chloroaniline solution, chlorhexidine and povidone iodine), improvised non-adhesive protective membrane (polyethylene) applied at the wound-bandage interface, bandages along with adhesive tape and systemic antibiotics. Healing occurred uneventfully within 6 weeks of the intervention. The paper discusses the detail of the management initiated and how it greatly influenced the skin wound healing in dogs. In conclusion, proper initial assessment of wounds and appropriate treatment through rigorous wound assessment and bandaging are critical to success in the wound healing and restoration of tissue integrity. This management intervention could be further investigated in animals in order to improve the quality of cutaneous wounds management.
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Church, Deirdre, Sameer Elsayed, Owen Reid, Brent Winston i Robert Lindsay. "Burn Wound Infections". Clinical Microbiology Reviews 19, nr 2 (kwiecień 2006): 403–34. http://dx.doi.org/10.1128/cmr.19.2.403-434.2006.
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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.
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Noskiewicz, Jakub, Paweł Juszczak, Małgorzata Rzanny- Owczarzak i Przemysław Mańkowski. "Antibiotic therapy and infection complications in paediatric burn injuries". Postępy Higieny i Medycyny Doświadczalnej 73 (15.05.2019): 1–8. http://dx.doi.org/10.5604/01.3001.0013.2019.
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Background: Each year, nearly 1% of population suffers from burn injuries. The main cause of complications and death after thermal injury is infections. Excessive use of antibiotics affects however the children treated for burns and can have negative effects. Therefore, specifying the recommendations for antibiotic therapy in patients after thermal injury seems to be of importance. Materials and methods: An evaluation of 310 paediatric patients hospitalised for burn injuries was performed. In the first part of evaluation, a retrospective analysis of treatment with particular focus on infection complications and administered antibiotics was performed. This was followed by a prospective evaluation of effectiveness of the principles of antibiotic therapy specified at the earlier stage. Results: In 2010-2016, an antibiotic was systemically administered to 53.4% of children treated for thermal injury, provided that in 87.1% of cases it was introduced as a prophylactic measure. Infection of a burn wound was recorded in 4.7% of cases. The most frequently isolated bacterium (57.1%) was Staphylococcus aureus MSSA. Supply of antibiotics failed to reduce the number of infection complications or burn wound infections. The studies formed the basis for specification of the internal antibiotic therapy criteria, effectiveness of which was then evaluated. In 2017, an antibiotic was administered to 37.1% of patients. Reducing antibiotic therapy did not increase the risk of infection complications or frequency of wound infections. Conclusion: Routine antibiotic prophylaxis in burn injuries has no effect on the risk of infection complications and does not reduce the treatment time. It should be limited to perioperative prophylaxis in the case of skin grafts and to the patients with progressing symptoms of burn disease or with concomitant infections.
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Gillen, Marion, Jennifer McNary, Julieann Lewis, Martha Davis, Alisa Boyd, Mary Schuller, Chris Curran, Carol A. Young i James Cone. "Sharps-Related Injuries in California Healthcare Facilities: Pilot Study Results From the Sharps Injury Surveillance Registry". Infection Control & Hospital Epidemiology 24, nr 2 (luty 2003): 113–21. http://dx.doi.org/10.1086/502181.
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AbstractBackground and Objectives:In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California.Results:Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network.Conclusion:These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.
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Mende, Katrin, Kevin S. Akers, Stuart D. Tyner, Jason W. Bennett, Mark P. Simons, Dana M. Blyth, Ping Li, Laveta Stewart i David R. Tribble. "Multidrug-Resistant and Virulent Organisms Trauma Infections: Trauma Infectious Disease Outcomes Study Initiative". Military Medicine 187, Supplement_2 (1.05.2022): 42–51. http://dx.doi.org/10.1093/milmed/usab131.
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ABSTRACT Introduction During the wars in Iraq and Afghanistan, increased incidence of multidrug-resistant (MDR) organisms, as well as polymicrobial wounds and infections, complicated the management of combat trauma–related infections. Multidrug resistance and wound microbiology are a research focus of the Trauma Infectious Disease Outcomes Study (TIDOS), an Infectious Disease Clinical Research Program, Uniformed Services University, research protocol. To conduct comprehensive microbiological research with the goal of improving the understanding of the complicated etiology of wound infections, the TIDOS MDR and Virulent Organisms Trauma Infections Initiative (MDR/VO Initiative) was established as a collaborative effort with the Brooke Army Medical Center, Naval Medical Research Center, U.S. Army Institute of Surgical Research, and Walter Reed Army Institute of Research. We provide a review of the TIDOS MDR/VO Initiative and summarize published findings. Methods Antagonism and biofilm formation of commonly isolated wound bacteria (e.g., ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.), antimicrobial susceptibility patterns, and clinical outcomes are being examined. Isolates collected from admission surveillance swabs, as part of infection control policy, and clinical infection workups were retained in the TIDOS Microbiological Repository and associated clinical data in the TIDOS database. Results Over the TIDOS study period (June 2009 to December 2014), more than 8,300 colonizing and infecting isolates were collected from military personnel injured with nearly one-third of isolates classified as MDR. At admission to participating U.S. military hospitals, 12% of wounded warriors were colonized with MDR Gram-negative bacilli. Furthermore, 27% of 913 combat casualties with ≥1 infection during their trauma hospitalization had MDR Gram-negative bacterial infections. Among 335 confirmed combat-related extremity wound infections (2009–2012), 61% were polymicrobial and comprised various combinations of Gram-negative and Gram-positive bacteria, yeast, fungi, and anaerobes. Escherichia coli was the most common Gram-negative bacilli isolated from clinical workups, as well as the most common colonizing MDR secondary to extended-spectrum β-lactamase resistance. Assessment of 479 E. coli isolates collected from wounded warriors found 188 pulsed-field types (PFTs) from colonizing isolates and 54 PFTs from infecting isolates without significant overlap across combat theaters, military hospitals, and study years. A minority of patients with colonizing E. coli isolates developed subsequent infections with the same E. coli strain. Enterococcus spp. were most commonly isolated from polymicrobial wound infections (53% of 204 polymicrobial cultures). Patients with Enterococcus infections were severely injured with a high proportion of lower extremity amputations and genitourinary injuries. Approximately 65% of polymicrobial Enterococcus infections had other ESKAPE organisms isolated. As biofilms have been suggested as a cause of delayed wound healing, wound infections with persistent recovery of bacteria (isolates of same organism collected ≥14 days apart) and nonrecurrent bacterial isolates were assessed. Biofilm production was significantly associated with recurrent bacteria isolation (97% vs. 59% with nonrecurrent isolates; P < 0.001); however, further analysis is needed to confirm biofilm formation as a predictor of persistent wound infections. Conclusions The TIDOS MDR/VO Initiative provides comprehensive and detailed data of major microbial threats associated with combat-related wound infections to further the understanding of wound etiology and potentially identify infectious disease countermeasures, which may lead to improvements in combat casualty care.
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NAGAICHUK, VASYL, ROMAN CHORNOPYSHCHUK, OLEKSANDR NAZARCHUK, LUDMILA SIDORENKO, MYKOLA ZHELIBA i OLENA URVAN. "Experimental justification for prompt neutralization of traumatic action of thermal exo- and endogenous damage factors (morphological features)". Romanian Biotechnological Letters 26, nr 6 (30.12.2021): 3040–46. http://dx.doi.org/10.25083/rbl/26.6/3040-3046.
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Objective: morphological substantiation of efficiency of prompt neutralization of traumatic action of exogenous and endogenous damage factors in burn injuries in experimental conditions. After simulating the burns on 60 rats, the traumatic hyperthermic damage factors in the main group were immediately neutralized by a gauze napkin soaked in water. Depending on its duration, the animals were divided into subgroups. Such applications were not performed on the control group. The study involved histological examination of tissues. Animals of the main groups had the presence of histologically confirmed skin appendages with a formed scar of connective tissue without signs of inflammation. In animals of the control group there were no skin appendages, which indicates a deeper thermal damage to tissues and the impossibility of self-epithelialization of wounds. These results confirm the importance and necessity of prompt neutralization of the traumatic effect of damage factors as the main elements of burn depth formation.
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Choi, Hye Jin, Jung Hoon Ahn, Seong-Hwan Park, Kee Hun Do, Juil Kim i Yuseok Moon. "Enhanced Wound Healing by Recombinant Escherichia coli Nissle 1917 via Human Epidermal Growth Factor Receptor in Human Intestinal Epithelial Cells: Therapeutic Implication Using Recombinant Probiotics". Infection and Immunity 80, nr 3 (19.12.2011): 1079–87. http://dx.doi.org/10.1128/iai.05820-11.
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The gastrointestinal mucosa has a remarkable ability to repair damage with the support of epidermal growth factor (EGF), which stimulates epithelial migration and proliferative reepithelialization. For the treatment of mucosal injuries, it is important to develop efficient methods for the localized delivery of mucoactive biotherapeutics. The basic idea in the present study came from the assumption that an intestinal probiotic vehicle can carry and deliver key recombinant medicinal proteins to the injured epithelial target in patients with intestinal ulcerative diseases, including inflammatory bowel disease. The study was focused on the use of the safe probioticE. coliNissle 1917, which was constructed to secrete human EGF in conjunction with the lipase ABC transporter recognition domain (LARD). Using thein vitrophysically wounded monolayer model, ABC transporter-mediated EGF secretion by probioticE. coliNissle 1917 was demonstrated to enhance the wound-healing migration of human enterocytes. Moreover, the epithelial wound closure was dependent on EGF receptor-linked activation, which exclusively involved the subsequent signaling pathway of the mitogen-activated protein kinase kinase (MEK) extracellular-related kinases 1 and 2 (ERK1/2). In particular, the migrating frontier of the wounded edge displayed the strongest EGF receptor-linked signaling activation in the presence of the recombinant probiotic. The present study provides a basis for the clinical application of human recombinant biotherapeutics via an efficient, safe probiotic vehicle.
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Gupta, Shivali, Jian-Jun Wen i Nisha Jain Garg. "Oxidative Stress in Chagas Disease". Interdisciplinary Perspectives on Infectious Diseases 2009 (2009): 1–8. http://dx.doi.org/10.1155/2009/190354.
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There is growing evidence to suggest that chagasic myocardia are exposed to sustained oxidative stress induced injuries that may contribute to disease progression. Trypanosoma cruzi invasion- and replication-mediated cellular injuries and immune-mediated cytotoxic reactions are the common source of reactive oxygen species (ROS) during acute infection. Mitochondria are proposed to be the major source of ROS in chronic chagasic hearts. However, it has not been established yet, whether mitochondrial dysfunction is a causative factor in chagasic cardiomyopathy or a consequence of other pathological events. A better understanding of oxidative stress in relation to cardiac tissue damage would be useful in the evaluation of its true role in the pathogenesis of Chagas disease and other heart diseases. In this review, we discuss the evidence for increased oxidative stress in chagasic disease, with emphasis on mitochondrial abnormalities, and its role in sustaining oxidative stress in myocardium.
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Shim, Hyung Sup, Ji Seon Choi i Sang Wha Kim. "A Role for Postoperative Negative Pressure Wound Therapy in Multitissue Hand Injuries". BioMed Research International 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/3629643.
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In this study, we compared outcomes in patients with acute hand injury, who were managed with or without negative pressure wound therapy (NPWT) after reconstructive surgery. All of the patients who sustained acute and multitissue injuries of the hand were identified. After reconstructive surgery, a conventional dressing was applied in Group 1 and NPWT was applied in Group 2. The dressing and NPWT were changed every 3 days. The mean age and Hand Injury Severity Scoring System score of both groups were not significantly different. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were evaluated 1 month after all the sutures were removed and 1 year postoperatively, which were both significantly lower in Group 2. Applying NPWT to the hand promoted wound healing by reducing edema, stabilizing the wound, and providing immobilization in a functional position. Early wound healing and decreased complications enabled early rehabilitation, which led to successful functional recovery, both objectively and subjectively.
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Snavely, Joseph E., Benjamin C. Service, Daniel Miller, Joshua R. Langford i Kenneth J. Koval. "Needlestick and sharps injuries in orthopedic surgery residents and fellows". Infection Control & Hospital Epidemiology 40, nr 11 (26.09.2019): 1253–57. http://dx.doi.org/10.1017/ice.2019.262.
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AbstractObjective:Needlestick and sharps injury (NSSI) is a common occupational hazard of orthopedic surgery training. The purpose of this study was to examine the incidence and surrounding circumstances of intraoperative NSSI in orthopedic surgery residents and fellows and to examine postexposure reporting.Design:A 35-question cross-sectional survey.Setting:The study was conducted by orthopedic surgery residents and faculty at a nonprofit regional hospital.Participants:The questionnaire was distributed to US allopathic orthopedic surgery residency and fellowship programs; 300 orthopedic surgery trainees participated in the survey.Results:Of 223 trainees who had completed at least 1 year of residency, 172 (77.1%) sustained an NSSI during residency, and 57 of 63 trainees (90.5%) who had completed at least 4 years sustained an NSSI during residency. The most common causes of NSSI were solid needles, followed by solid pins or wires. The surgical activity most associated with NSSI was wound closure, followed by fracture fixation. The type of surgery most frequently associated with NSSI was orthopedic trauma, followed by hip and knee arthroplasty. Of 177 trainees who had sustained a prior NSSI, 99 (55.9%) failed to report all events to their institution’s occupational health department.Conclusions:The incidence of NSSI during residency training is high, with >90% of trainees in their fifth year or later of training having received an injury during their training, with a mean of >4 separate events. Most trainees with an NSSI did not report all of their events, which implies that changes are needed in the incident reporting process universally.
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Zhou, Panpan, Xue Li, Bing Zhang, Qing Shi, Dong Li i Xiuli Ju. "A Human Umbilical Cord Mesenchymal Stem Cell-Conditioned Medium/Chitosan/Collagen/β-Glycerophosphate Thermosensitive Hydrogel Promotes Burn Injury Healing in Mice". BioMed Research International 2019 (2.12.2019): 1–14. http://dx.doi.org/10.1155/2019/5768285.
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We investigated the effects of a human umbilical cord mesenchymal stem cell-conditioned medium (MSC-CM)/chitosan/collagen/β-glycerophosphate (β-GP) thermosensitive hydrogel (MSC-CM/hydrogel) on mice with third-degree burns. MSC-CM was collected and mixed with chitosan, collagen, and β-GP to generate the thermosensitive MSC-CM/hydrogel, which was stored in the liquid phase at 4°C. The wounds of established third-degree burned mice were then externally covered with the MSC-CM/hydrogel, which formed a gel when placed on the wounds at physiological temperature. Injured mice in three additional groups were treated with unconditioned MSC medium (UM), MSC-CM, or UM/chitosan/collagen/β-GP thermosensitive hydrogels. Skin wound samples were obtained 4, 14, and 28 days after burning for further analysis by hematoxylin and eosin and Ki-67 staining. Wound healing rates and times, in addition to immunohistochemical results, were then compared and analyzed among the four groups. Application of the MSC-CM/hydrogel shortened healing time, limited the area of inflammation, enhanced reepithelialization, promoted the formation of high-quality, well-vascularized granulation tissue, and attenuated the formation of fibrotic and hypertrophic scar tissue. In summary, MSC-CM/hydrogel effectively promotes wound healing in third-degree burned mice.
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Tan, Woan Sean, Palanisamy Arulselvan, Shiow-Fern Ng, Che Norma Mat Taib, Murni Nazira Sarian i Sharida Fakurazi. "Healing Effect of Vicenin-2 (VCN-2) on Human Dermal Fibroblast (HDF) and Development VCN-2 Hydrocolloid Film Based on Alginate as Potential Wound Dressing". BioMed Research International 2020 (24.04.2020): 1–15. http://dx.doi.org/10.1155/2020/4730858.
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Chronic wounds represent serious globally health care and economic issues especially for patients with hyperglycemic condition. Wound dressings have a predominant function in wound treatment; however, the dressings for the long-lasting and non-healing wounds are still a significant challenge in the wound care management market. Astonishingly, advanced wound dressing which is embedded with a synthetic drug compound in a natural polymer compound that acts as drug release carrier has brought about promising treatment effect toward injured wound. In the current study, results have shown that Vicenin-2 (VCN-2) compound in low concentration significantly enhanced cell proliferation and migration of HDF. It also regulated the production of pro-inflammatory cytokines such as IL-6, IL-1β, and TNF-α from HDF in wound repair. Treatment of VCN-2 also has facilitated the expression of TGF-1β and VEGF wound healing maker in a dose-dependent manner. A hydrocolloid film based on sodium alginate (SA) incorporated with VCN-2 synthetic compound which targets to promote wound healing particularly in diabetic condition was successfully developed and optimized for its physico-chemical properties. It was discovered that all the fabricated film formulations prepared were smooth, translucent, and good with flexibility. The thickness and weight of the formulations were also found to be uniform. The hydrophilic polymer comprised of VCN-2 were shown to possess desirable wound dressing properties and superior mechanical characteristics. The drug release profiles have revealed hydrocolloid film, which is able to control and sustain the VCN-2 released to wound area. In short, hydrocolloid films consisting of VCN-2 formulations are suitably used as a potential wound dressing to promote restoration of wound injury.
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Abedini, Fateme, Shahla Roudbar Mohammadi, Mostafa Dahmardehei, Marjan Ajami, Maryam Salimi, Halala Khalandi, Monireh Mohsenzadegan i in. "Enhancing of Wound Healing in Burn Patients through Candida albicans β-Glucan". Journal of Fungi 8, nr 3 (4.03.2022): 263. http://dx.doi.org/10.3390/jof8030263.
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The mortality and disability-adjusted life years (DALYs) of burn patients are decreasing over time. However, finding novel effective treatment approaches using natural agents is highly considered to reduce the burden of burn injuries. One of the recent agents used in wound healing is β-glucan, mainly extracted from fungi cell walls. This study aimed to evaluate the effect of 5% (m/m) of yeast β-glucan ointment on burn wound healing and to assess the impact of β-glucan on cytokines during the treatment. Thirty-three patients with second or third-degree burns were enrolled in this study. Two groups of twenty-three and ten patients used yeast 5% (m/m) β-glucan ointment (study group) and Stratamed ointment (control), respectively, on a daily basis, for a maximum of four weeks. The size of the burn wounds was measured before and at the end of the treatment. Blood samples of 14 and 10 patients in the β-glucan and control groups, respectively, were obtained before and after the treatment, and the enzyme-linked immunosorbent assay (ELISA) was performed to measure the serum concentration of the IL-4, IL-17, and IFN-γ cytokines. The log-binomial model was used to assess the efficacy of the β-glucan ointment on burn wound healing. ANOVA/ANCOVA was employed to assess the effects of β-glucan on the serum concentration of cytokines. After adjusting for potential confounders/covariates, patients receiving β-glucan had better wound healing (RR = 4.34; 95% CI: 0.73 to 25.67; p = 0.11). There was a significant difference in IL-4 secretion between the β-glucan and control groups after adjusting for potential confounders/covariates (MD = 77.27; 95% CI: 44.73 to 109.82; Cohen’s d = 2.21; 95% CI: 1.16 to 3.24; p = 0.0001). The results indicate that 5% (m/m) of β-glucan has efficacy in burn wound healing, and a significant difference was found in the level of IL-4 after receiving β-glucan. Further studies with a two-arm design and long-term use of ointment are needed to confirm the effect of β-glucan on wound healing and cytokine secretion.
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Hladík, Martin, Bretislav Lipovy, Yvona Kaloudova, Marketa Hanslianova, Ivana Vitkova, Tereza Deissova, Tomas Kempny i in. "Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe". Microorganisms 9, nr 9 (11.09.2021): 1934. http://dx.doi.org/10.3390/microorganisms9091934.
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Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae. Here, we present a unique case report of the first W. chitiniclastica isolation from a burn wound with accidental myiasis in a 63-year-old homeless man and a literature review focused on human infections caused by these bacteria. So far, 23 cases of infection with W. chitiniclastica have been reported; in 52% of these, larvae were found in the wound area. Most of these cases suffered from chronic non-healing wound infections but none of these were burn injuries. The overall fatality rate associated directly with W. chitiniclastica in these cases was 17%. Infections with parasitic larvae occur in moderate climates (especially in people living in poor conditions); therefore, an infection with rare bacteria associated with accidental myiasis, such as W. chitiniclastica, can be expected to become more common there. Thus, in view of the absence of recommendations regarding the treatment of patients with accidental myiasis and, therefore, the risk of infection with W. chitiniclastica or other rare pathogens, we provide a list of recommendations for the treatment of such patients. The importance of meticulous microbial surveillance using molecular biological methods to facilitate the detection of rare pathogens is emphasized.
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Stewart, Laveta, Ping Li, Dana M. Blyth, Dana M. Blyth, Joseph Petfield, Wesley R. Campbell i David Tribble. "449. Epidemiology of Combat-Related Deep Soft-Tissue Wound Infections". Open Forum Infectious Diseases 6, Supplement_2 (październik 2019): S221. http://dx.doi.org/10.1093/ofid/ofz360.522.
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Abstract Background Deep soft-tissue infections (DSTIs) are a common complication of combat-related extremity trauma. We present an epidemiologic assessment of combat-related DSTIs among wounded military personnel. Methods Wounded personnel were included in the analysis if they sustained an open combat-related extremity wound (2009–2014), were admitted to a participating US military hospital, had a DSTI as the first confirmed extremity wound infection (within 30 days post-injury), started antibiotics ±3 days of DSTI diagnosis, and received ≥5 days of directed antibiotic treatment. Results Among 1961 combat casualties with open extremity wounds, 259 had a DSTI diagnosis with 173 (67%) having only 1 index DSTI and 86 (33%) having >1 index DSTI diagnosed on the same day. Nearly all patients (95%) were injured via a blast mechanism. Patients with >1 index DSTI were more severely injured (median injury severity score: 35 vs. 33; P = 0.009) and required large volume blood transfusions within 24 hours of injury (median units: 23 vs. 17; P < 0.001). Initial empiric antibiotic treatment largely involved carbapenem and vancomycin (77% and 72% of patients, respectively). For diagnosis timing, 130 (50%) patients had an early DSTI diagnosis (≤7 days post-injury), while the remaining 129 (50%) patients had a delayed diagnosis (>7 days post-injury). Patients with early DSTI diagnoses more often had >1 index DSTI (47% vs. 19% with delayed DSTI; P < 0.001). Polymicrobial DSTIs were common (73% of early DSTIs; 58% of delayed DSTIs) with Enterococcus spp. most frequently identified (56% of early DSTIs; 31% of delayed DSTIs) as well as Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. Moreover, 26% and 39% of early and delayed DSTIs had multidrug-resistant Gram-negative bacteria. Receipt of >20 units of blood within 24 hours of injury and having >1 index DSTI were independently associated with an early DSTI diagnosis (odds ratio [OR]: 3.21; 95% CI: 1.47–7.02 and OR: 2.98; 95% CI: 1.63–5.42, respectively). Conclusion Multiple index DSTIs and massive blood transfusion requirement are associated with early infection onset post-injury. Awareness of wound microbiology findings relative to DSTI onset provides guidance on empiric antimicrobial therapy. Disclosures All authors: No reported disclosures.
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Kiley, John, Katrin Mende, Susan J. Kaiser, Leigh Carson, Dan Z. Lu, Timothy J. Whitman, Joseph L. Petfield, David R. Tribble i Dana M. Blyth. "1198. Clinical Characteristics and Outcomes of Klebsiella pneumoniae Infections in Service Members Who Sustained Trauma in Iraq and Afghanistan". Open Forum Infectious Diseases 5, suppl_1 (listopad 2018): S362—S363. http://dx.doi.org/10.1093/ofid/ofy210.1031.
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Abstract Background Klebsiella pneumoniae infections present a challenge to the clinician due to increasing resistance. K. pneumoniae was the third most common species of multidrug-resistant (MDR) Gram-negative organism in trauma patients sustaining injuries in Iraq and Afghanistan from 2009 to 2014. This study aims to elucidate the epidemiology of these infections by characterizing clinical aspects, risk for MDR infections, and outcomes. Methods All initial and serial (≥7 days from prior isolate) infecting K. pneumoniae isolates were collected from the Trauma Infectious Disease Outcomes Study (TIDOS) (6/09-12/14). Antimicrobial susceptibilities were determined using the BD Phoenix Automated Microbiology System and CLSI criteria. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC. Results Of 588 K. pneumoniae isolates in the TIDOS registry, 141 infecting isolates (98 initial) from 51 patients met inclusion criteria. Initial isolates were respiratory (31%), wound (25%), blood (20%), urine (10%), intra-abdominal (8%) and other (6%). All patients were male with a median age of 23 years (IQR 21–28). The majority of patients (82%) suffered blast injuries; of which, 88% were from improvised explosive devices. Patients had a median injury severity score (ISS) of 38 (IQR 30–45) and time from injury to first infecting K. pneumoniae isolate was 15 days (IQR 8–31). The median hospital stay was 49 days (IQR 28–70) and four patients died. All patients had received antibiotics prior to diagnosis. Twenty-three (46%) patients had initial isolates classified as MDR. There was no difference in age, ISS, or time from injury to first isolation among those who did and did not have initial MDR isolates. Sixteen patients had 64 serial isolates, of which 24 were wound, 20 respiratory, 14 blood and six urine. Three of these 16 patients died compared with 1 of 35 patients without serial isolates. Conclusion K. pneumoniae infections are common among combat casualties. Patients with K. pneumoniae infections were severely injured and almost half of initial infecting isolates were MDR, complicating treatment. Disclosures All authors: No reported disclosures.
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Pujji, Ojas Jyoti Singh, Kiran Kishor Nakarmi, Basudha Shrestha, Shankar Man Rai i Steven Leonard Alexander Jeffery. "The Bacteriological Profile of Burn Wound Infections at a Tertiary Burns Center in Nepal". Journal of Burn Care & Research 40, nr 6 (13.06.2019): 838–45. http://dx.doi.org/10.1093/jbcr/irz096.
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AbstractIn Nepal, burn is the third most common injury after falls and road traffic accidents. Infection is the leading cause of mortality in burn injury. A profile exploring predominant flora and antimicrobial sensitivity is important to facilitate treatment ahead of microbiology results and to aid prevention of multidrug-resistant organisms. The aim of this study was to document epidemiological and bacteriological data of burn wound infections at a tertiary level burns center in Nepal. Samples were collected from January 2017 to May 2017, over a period of 5 months. Patient notes were referred to and information regarding baseline characteristics and burn wound infection data was collected. A total of 76 patients were included in the study during the 5-month period, which resulted in 113 samples being included for review. Females were injured most with burns 70% (n = 53) compared with males 30% (n = 23). Only 6 (8%) of 77 patients lived locally in Kathmandu. The average distance traveled by patients was 233 km (median 208, range 0–765, SD 181). Average TBSA% of burn was 22% (median 20, range 3–50, SD 12). Gram-negative organisms predominated, with Acinetobacter spp. in 42 cases (55%), Pseudomonas aeruginosa in 26 cases (34%), and Enterobacter spp. in 16 cases (21%). Colistin, polymyxin B, and tigecycline were found to be most sensitive covering 108, 98, and 94 organisms. Gram-negative bacteria colonized the majority of burn wounds. Colistin, polymyxin B, and tigecycline were the most sensitive to gram-negative bacteria. Gram-positive Staphylococcus aureus was sensitive most to vancomycin and tigecycline.
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Lisa, Andrea Vittorio Emanuele, Leonardo Galtelli, Valeriano Vinci, Alessandra Veronesi, Luca Cozzaglio, Ferdinando Carlo Maria Cananzi, Federico Sicoli i Marco Klinger. "Adoption of a Newly Introduced Dermal Matrix: Preliminary Experience and Future Directions". BioMed Research International 2020 (16.10.2020): 1–5. http://dx.doi.org/10.1155/2020/3261318.
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Introduction. Acellular dermal matrix (ADM) products are adopted in the management of injuries to soft tissues. ADMs have been increasingly employed for their clinical advantages, and they are acquiring relevance in the future of plastic surgery. The aim of our study is to evaluate the application of ADMs in our patients who could not undergo fast reconstruction. Materials and Methods. We performed a retrospective study on 12 patients who underwent ADM placement for scalp and limb surgical reconstructions at the Humanitas Research Hospital, Rozzano (Milano), Italy. Wounds resulted from 9 tumor resections and 3 chronic ulcers. The ADM substrate used to treat these lesions was PELNAC™ (Gunze, Japan), a double-layered matrix composed of atelocollagen porcine tendon and silicon reinforcement. All patients underwent a second surgical operation to complete the treatment with a full-thickness skin graft to cover the lesion. Results. In this study, 12 patients were treated with PELNAC™: 11 out of 12 patients showed a good attachment over a median time of 21.3 days (range 14-27). After almost 23 days, all patients were ready to undergo a full-thickness skin grafting. Conclusion. This study assesses the benefits of PELNAC™ and proposes this method as an alternative to traditional approaches, especially in situations where the latter techniques cannot be applied.
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Tong, Xin, Peng-Yang Wang, Mei-Zhuo Jia, Randy Thornhill i Bao-Zhen Hua. "Traumatic mating increases anchorage of mating male and reduces female remating duration and fecundity in a scorpionfly species". Proceedings of the Royal Society B: Biological Sciences 288, nr 1952 (2.06.2021): 20210235. http://dx.doi.org/10.1098/rspb.2021.0235.
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Traumatic mating is the male wounding his mate during mating using specialized anatomy. However, why males have evolved to injure their mates during mating remains poorly understood. We studied traumatic mating in Dicerapanorpa magna to determine its effects on male and female fitness. The sharp teeth on male gonostyli penetrate the female genitalia and cause copulatory wounds, and the number of scars on the female genitals is positively related to the number of times females mated. When the injurious teeth were encased with low-temperature wax, preventing their penetration of the female's genitalia during mating, male mating success and copulation duration were reduced significantly, indicating the importance of the teeth in allowing the male to secure copulation, remain in copula and effectively inseminate his mate. The remating experiments showed that traumatic mating had little effect on the female mating refractory period, but significantly reduced female remating duration with subsequent males, probably benefiting the first-mating male with longer copulation duration and transferring more sperm into the female's spermatheca. The copulatory wounds reduced female fecundity, but did not accelerate the timing of egg deposition. This is probably the first report that traumatic mating reduces female remating duration through successive remating experiments in animals. Overall, our results provide evidence that traumatic mating in the scorpionfly helps increase the male's anchoring control during mating and provides him advantage in sperm competition, but at the expense of lowering female fecundity.
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Machado, H. A., J. J. Abercrombie, T. You, P. P. DeLuca i K. P. Leung. "Release of a Wound-Healing Agent from PLGA Microspheres in a Thermosensitive Gel". BioMed Research International 2013 (2013): 1–11. http://dx.doi.org/10.1155/2013/387863.
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The purpose of this research was to develop a topical microsphere delivery system in a thermosensitive 20% poloxamer 407 gel (Pluronic F127) to control release of KSL-W, a cationic antimicrobial decapeptide, for a period of 4–7 days for potential application in combat related injuries. KSL-W loaded microsphere formulations were prepared by a solvent extraction-evaporation method (water-oil-water), with poly (D,L-lactic-co-glycolic acid) (PLGA) (50 : 50, low-weight, and hydrophilic end) as the polymeric system. After optimization of the process, three formulations (A, B, and C) were prepared with different organic to water ratio of the primary emulsion while maintaining other components and manufacturing parameters constant. Formulations were characterized for surface morphology, porous nature, drug loading,in vitrodrug release, and antimicrobial activity. Microspheres containing 20% peptide with porous surfaces and internal structure were prepared in satisfactory yields and in sizes varying from 25 to 50 μm. Gels of 20% Pluronic F127, which were liquid at or below 24.6°C and formed transparent films at body temperature, were used as carriers for the microspheres. Rheological studies showed a gelation temperature of 24.6°C for the 20% Pluronic F127 gel alone. Gelation temperature and viscosity of formulations A, B, and C as a function of temperature were very close to those of the carrier. A Franz diffusion cell system was used to study the release of peptide from the microspheres suspended in both, phosphate-buffered saline (PBS) and a 20% Pluronic F127 gel.In vitrorelease of greater than 50% peptide was found in all formulations in both PBS and the gel, and in one formulation there was a release of 75% in both PBS and the gel. Fractions collected from the release process were also tested for bactericidal activity againstStaphylococcus epidermidisusing the broth microdilution method and found to provide effective antimicrobial activity to warrant consideration and testing in animal wound models for treating combat-related injuries.
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Chen, Amy Y., Michael G. Stewart i Glenn Raup. "Penetrating Injuries of the Face". Otolaryngology–Head and Neck Surgery 115, nr 5 (listopad 1996): 464–70. http://dx.doi.org/10.1177/019459989611500519.
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We reviewed 78 consecutive cases of penetrating facial injuries treated at Ben Taub General Hospital in Houston, Texas, between 1992 and 1994, and we analyzed injury patterns on the basis of (1) the mechanism of injury, and (2) the entry zone of the wounds. We found that gunshot wounds were more likely to require emergent airway establishment than shotgun wounds or stab wounds ( p = 0.03). We noted a higher prevalence of globe injury among shotgun wounds than among gunshot wounds ( p = 0.02). Nine (12%) patients had intracranial penetration of a bullet or shotgun pellet. Patients with gunshot wounds required open reduction and internal fixation of facial bone fractures more frequently than patients with shotgun wounds ( p = 0.01). Thirty patients underwent arteriograms, and 10 demonstrated positive findings. Although there were only 3 deaths in our series, 29 (37%) patients overall had some complication caused by their penetrating facial trauma, including blindness in 12 patients. There was no significant difference in the prevalence of complications between gunshot, shotgun, and stab wounds ( p = 0.18). With these injury patterns in mind, we describe an algorithm for evaluation and management of penetrating injuries of the face.
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Liao, Ching-Hsing, i Peter H. Cooke. "Response to trisodium phosphate treatment ofSalmonellaChester attached to fresh-cut green pepper slices". Canadian Journal of Microbiology 47, nr 1 (1.01.2001): 25–32. http://dx.doi.org/10.1139/w00-116.
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A laboratory model using green pepper disks was developed to investigate the attachment of Salmonella Chester on plant tissue and to evaluate the effectiveness of sanitizer agents in inactivating attached bacteria on fruits. Pepper disks (14 mm in diam, and 3-4 mm in thickness) were immersed in a bacterial suspension containing 1.5 × 107cfu·mL-1of S. Chester for 30 s and subsequently air-dried at room temperature for 10 min. Approximately 30% of the bacteria retained on the disk after immersion were firmly attached and could not be removed by two washes and agitation. A positive correlation was observed between the number of bacteria attached and the concentration of bacteria in the suspension. Population studies and scanning electron microscopic examinations revealed that attachment of S. Chester on pepper disks occurred mainly on the surfaces of injured (cut) tissue but rarely on the unbroken skin. When inoculated disks were treated with 3% to 12% (w/v) of trisodium phosphate (TSP) at pH 12.3 for 5 min, the population of bacteria on the disk was reduced by 10- to 100-fold. A small portion (0.7% to 7.1%) of bacteria attached to the disk were either resistant to or protected from the TSP treatment. When the pH of TSP solution was reduced from 12.3 to 4.5, the effectiveness of TSP in inactivating S. Chester on pepper disks was reduced by 26%. This study shows that surfaces of injured fruit tissue are the principal sites for bacterial attachment, and a small portion of the bacteria attached to the tissue are resistant to the sanitizer treatment. Avoiding mechanical injuries to fresh fruits during and after harvest would reduce the chance of pathogen attachment and contamination on green pepper and fruits of similar nature.Key words: Salmonella, attachment, detachment, plant tissue, sanitizer treatment.
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Maslyakov, VV, EV Krjukov, VG Barsukov, KG Kurkin, PA Dorzhiev i VR Gorbelik. "Heart injuries: main clinical symptoms". Laboratory diagnostics, nr 1 (27.02.2019): 53–56. http://dx.doi.org/10.24075/brsmu.2019.003.
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Injuries to the heart are uncommon in peacetime, yet they result in life-threatening conditions, which makes timely diagnostics a crucial factor in saving patients' lives. In this connection, it is important to define the main signs of heart injuries. This study aimed to analyze the basic clinical symptoms associated with various wounds to the heart. We have retrospectively analyzed such symptoms registered in 86 patients with varying chest injuries that affect the heart. All patients were treated in the emergency surgery unit of the Engels Town Hospital from 1991 to 2017. 41 (47.6%) patient had stab wounds, and there were 45 (52.3%) cases of gunshot wounds. 23 (26.7%) patients had chest injuries affecting heart exclusively, while for 63 (73.2%) the consequences were wounds to other organs. We found that the clinical picture depends on the kind of injury to the heart: stab and slash wounds translate into more pronounced symptoms, while gunshot wounds do not produce such an effect. Accepting patients, practitioners should take this fact into account. The misdiagnosis rate for stab and slash heart wounds is 9.7%, that for gunshot wounds — 17.7%, the latter being the result of vagueness of the clinical picture. The clinical signs are most pronounced in the cases of stab and slash wounds to the heart.
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Burggraf, Manuel, Christina Polan, Heinz-Lothar Meyer, Roman Maximilian Müller, Felix Reinecke, Marcel Dudda i Max Daniel Kauther. "A Selection of Trauma Scores Might Not Correlate with Coagulation Factor Activity following Multiple Injuries: A Retrospective Observational Study from a Level 1 Trauma Center". BioMed Research International 2020 (30.12.2020): 1–9. http://dx.doi.org/10.1155/2020/6726017.
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Loss and dilution of coagulation factors have been observed following multiple trauma. Timely recognition of reduced clotting factor activity might facilitate therapeutic action to restore normal coagulation function. This study investigates the potential role of some well-known trauma scores in predicting coagulation factor activity after multiple injuries. A dataset comprising the coagulation factor activities of 68 multiply injured adult patients was analyzed. The following trauma scores were evaluated: AIS, ISS, NISS, GCS, RTS, TRISS, RISC, and TASH score. To investigate the effect of trauma severity with respect to a single anatomic injury location, two groups according to the AIS (<3 vs. ≥3 points) were formed. Differences between these two groups were analyzed for five different body regions (head, thorax, abdomen, pelvis, extremities) using the Mann–Whitney U -test. Spearman’s rank correlation coefficient rho was calculated to reveal possible relationships between trauma scores and clotting factor activities. The analysis showed clearly reduced clotting factor activities with a significant reduction of FII (83 vs. 50%; P = .021 ) and FV (83 vs. 46%; P = .008 ) for relevant ( AIS ≥ 3 points ) pelvic injuries. In contrast, traumatic brain injury according to the AIS head or the GCS does not appear to lead to a significant decrease in coagulation factor activities. Furthermore, the other scores studied show at best a fair correlation with coagulation factor activity. In this context, the RTS score seems to be the most suitable. Additionally, the predictive value of the TASH score, which was specifically developed to predict the need for mass transfusion, was also limited in this study. We would like to explicitly point out that this is not a criticism of the trauma scores, since they were developed in a completely different context.
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Wang, Zhengquan, Lifeng Wu, Jiefeng Xu, Jindan Gao, Sen Ye, Zilong Li, Yuanzhuo Chen i Xiangyu Zhang. "Limb Ischemic Postconditioning Alleviates Postcardiac Arrest Syndrome through the Inhibition of Mitochondrial Permeability Transition Pore Opening in a Porcine Model". BioMed Research International 2020 (16.04.2020): 1–9. http://dx.doi.org/10.1155/2020/9136097.
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Objective. Previously, the opening of mitochondrial permeability transition pore (mPTP) was confirmed to play a key role in the pathophysiology of postcardiac arrest syndrome (PCAS). Recently, we demonstrated that limb ischemic postconditioning (LIpostC) alleviated cardiac and cerebral injuries after cardiac arrest and resuscitation. In this study, we investigated whether LIpostC would alleviate the severity of PCAS through inhibiting mPTP opening. Methods. Twenty-four male domestic pigs weighing 37±2 kg were randomly divided into three groups: control, LIpostC, and LIpostC+atractyloside (Atr, the mPTP opener). Atr (10 mg/kg) was intravenously injected 30 mins prior to the induction of cardiac arrest. The animals were subjected to 10 mins of untreated ventricular fibrillation and 5 mins of cardiopulmonary resuscitation. Coincident with the beginning of cardiopulmonary resuscitation, LIpostC was induced by four cycles of 5 mins of limb ischemia and then 5 mins of reperfusion. The resuscitated animals were monitored for 4 hrs and observed for an additional 68 hrs. Results. After resuscitation, systemic inflammation and multiple organ injuries were observed in all resuscitated animals. However, postresuscitation systemic inflammation was significantly milder in the LIpostC group than in the control group. Myocardial, lung, and brain injuries after resuscitation were significantly improved in the LIpostC group compared to the control group. Nevertheless, pretreatment with Atr abolished all the protective effects induced by LIpostC. Conclusion. LIpostC significantly alleviated the severity of PCAS, in which the protective mechanism was associated with the inhibition of mPTP opening.
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Júnior, Dario Mendes, Moema A. Hausen, Jéssica Asami, Akemi M. Higa, Fabio L. Leite, Giovanni P. Mambrini, Andre L. Rossi, Daniel Komatsu i Eliana A. de Rezende Duek. "A New Dermal Substitute Containing Polyvinyl Alcohol with Silver Nanoparticles and Collagen with Hyaluronic Acid: In Vitro and In Vivo Approaches". Antibiotics 10, nr 6 (19.06.2021): 742. http://dx.doi.org/10.3390/antibiotics10060742.
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The experimental use of poly (alcohol-vinyl) (PVA) as a skin curative is increasing widely. However, the use of this hydrogel is challenging due to its favorable properties for microbiota growth. The association with silver nanoparticles (AgNPs) as an antimicrobial agent turns the match for PVA as a dressing, as it focuses on creating a physical barrier to avoid wound dehydration. When associated with extracellular components, such as the collagen matrix, the device obtained can create the desired biological conditions to act as a skin substitute. This study aimed to analyze the anti-microbiological activity and the in vitro and in vivo responses of a bilaminar device of PVA containing AgNPs associated with a membrane of collagen–hyaluronic acid (col-HA). Additionally, mesenchymal stem cells were cultured in the device to evaluate in vitro responses and in vivo immunomodulatory and healing behavior. The device morphology revealed a porous pattern that favored water retention and in vitro cell adhesion. Controlled wounds in the dorsal back of rat skins revealed a striking skin remodeling with new epidermis fulfilling all previously injured areas after 14 and 28 days. No infections or significant inflammations were observed, despite increased angiogenesis, and no fibrosis-markers were identified as compared to controls. Although few antibacterial activities were obtained, the addition of AgNPs prevented fungal growth. All results demonstrated that the combination of the components used here as a dermal device, chosen according to previous miscellany studies of low/mid-cost biomaterials, can promote skin protection avoiding infections and dehydration, minimize the typical wound inflammatory responses, and favor the cellular healing responses, features that give rise to further clinical trials of the device here developed
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Maurin, Olga, Stanislas de Régloix, Stéphane Dubourdieu, Hugues Lefort, Stéphane Boizat, Benoit Houze, Jennifer Culoma, Guillaume Burlaton i Jean-Pierre Tourtier. "Maxillofacial Gunshot Wounds". Prehospital and Disaster Medicine 30, nr 3 (14.04.2015): 316–19. http://dx.doi.org/10.1017/s1049023x1500463x.
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AbstractThe majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.MaurinO, de RégloixS, DubourdieuS, LefortH, BoizatS, HouzeB, CulomaJ, BurlatonG, TourtierJP. Maxillofacial gunshot wounds. Prehosp Disaster Med. 2015;30(3):14.
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Hao, Dandan, i Mahtab Nourbakhsh. "Recent Advances in Experimental Burn Models". Biology 10, nr 6 (12.06.2021): 526. http://dx.doi.org/10.3390/biology10060526.
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Experimental burn models are essential tools for simulating human burn injuries and exploring the consequences of burns or new treatment strategies. Unlike clinical studies, experimental models allow a direct comparison of different aspects of burns under controlled conditions and thereby provide relevant information on the molecular mechanisms of tissue damage and wound healing, as well as potential therapeutic targets. While most comparative burn studies are performed in animal models, a few human or humanized models have been successfully employed to study local events at the injury site. However, the consensus between animal and human studies regarding the cellular and molecular nature of systemic inflammatory response syndrome (SIRS), scarring, and neovascularization is limited. The many interspecies differences prohibit the outcomes of animal model studies from being fully translated into the human system. Thus, the development of more targeted, individualized treatments for burn injuries remains a major challenge in this field. This review focuses on the latest progress in experimental burn models achieved since 2016, and summarizes the outcomes regarding potential methodological improvements, assessments of molecular responses to injury, and therapeutic advances.
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de Rooster, H., O. Taeymans, H. van Bree i M. Risselada. "Penetrating injuries in dogs and cats". Veterinary and Comparative Orthopaedics and Traumatology 21, nr 05 (2008): 434–39. http://dx.doi.org/10.3415/vcot-07-02-0019.
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SummaryThe objective of this retrospective study was to assess radiographical and surgical findings, surgical management and outcome of penetrating injuries in dogs and cats by evaluating patient records. Sixteen patients were identified (15 dogs and one cat), four with gunshot wounds, and 12 with fight wounds (11 with bite wounds, one struck by a claw). The thoracic cavity was affected in six patients, the abdominal cavity in three cases. Both cavities were affected in five dogs and the trachea in two cases. All of the patients with fight wounds were small breed dogs. Multiple injuries to internal organs that required intervention were found surgically after gunshot wounds and a high amount of soft tissue trauma requiring reconstruction was present after fight wounds. Radiography diagnosed body wall disruption in two cases. All of the affected thoracic body walls in the fight group had intercostal muscle disruptions which was diagnosed surgically. Fourteen patients survived until discharge and had a good outcome. In conclusion, penetrating injuries should be explored as they are usually accompanied by severe damage to either the internal organs or to the body wall. A high level of awareness is required to properly determine the degree of trauma of intercostal muscle disruption in thoracic fight wounds.
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Rodriguez, (Ret ). Carlos J., Anuradha Ganesan, Faraz Shaikh, M. Leigh Carson, William Bradley, Tyler E. Warkentien i David R. Tribble. "Combat-Related Invasive Fungal Wound Infections". Military Medicine 187, Supplement_2 (1.05.2022): 34–41. http://dx.doi.org/10.1093/milmed/usab074.
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ABSTRACT Introduction During Operation Enduring Freedom in Afghanistan, an outbreak of combat-related invasive fungal wound infections (IFIs) emerged among casualties with dismounted blast trauma and became a priority issue for the Military Health System. Methods In 2011, the Trauma Infectious Disease Outcomes Study (TIDOS) team led the Department of Defense IFI outbreak investigation to describe characteristics of IFIs among combat casualties and provide recommendations related to management of the disease. To support the outbreak investigation, existing IFI definitions and classifications utilized for immunocompromised patients were modified for use in epidemiologic research in a trauma population. Following the conclusion of the outbreak investigation, multiple retrospective analyses using a population of 77 IFI patients (injured during June 2009 to August 2011) were conducted to evaluate IFI epidemiology, wound microbiology, and diagnostics to support refinement of Joint Trauma System (JTS) clinical practice guidelines. Following cessation of combat operations in Afghanistan, the TIDOS database was comprehensively reviewed to identify patients with laboratory evidence of a fungal infection and refine the IFI classification scheme to incorporate timing of laboratory fungal evidence and include categories that denote a high or low level of suspicion for IFI. The refined IFI classification scheme was utilized in a large-scale epidemiologic assessment of casualties injured over a 5.5-year period. Results Among 720 combat casualties admitted to participating hospitals (2009-2014) who had histopathology and/or wound cultures collected, 94 (13%) met criteria for an IFI and 61 (8%) were classified as high suspicion of IFI. Risk factors for development of combat-related IFIs include sustaining a dismounted blast injury, experiencing a traumatic transfemoral amputation, and requiring resuscitation with large-volume (>20 units) blood transfusions. Moreover, TIDOS analyses demonstrated the adverse impact of IFIs on wound healing, particularly with order Mucorales. A polymerase chain reaction (PCR)-based assay to identify filamentous fungi and support earlier IFI diagnosis was also assessed using archived formalin-fixed, paraffin-embedded tissue specimens. Although the PCR-based assay had high specificity (99%), there was low sensitivity (63%); however, sensitivity improved to 83% in tissues collected from sites with angioinvasion. Data obtained from the initial IFI outbreak investigation (37 IFI patients) and subsequent TIDOS analyses (77 IFI patients) supported development and refinement of a JTS clinical practice guideline for the management of IFIs in war wounds. Furthermore, a local clinical practice guideline to screen for early tissue-based evidence of IFIs among blast casualties at the Landstuhl Regional Medical Center was critically evaluated through a TIDOS investigation, providing additional clinical practice support. Through a collaboration with the Uniformed Services University Surgical Critical Care Initiative, findings from TIDOS analyses were used to support development of a clinical decision support tool to facilitate early risk stratification. Conclusions Combat-related IFIs are a highly morbid complication following severe blast trauma and remain a threat for future modern warfare. Our findings have supported JTS clinical recommendations, refined IFI classification, and confirmed the utility of PCR-based assays as a complement to histopathology and/or culture to promote early diagnosis. Analyses underway or planned will add to the knowledge base of IFI epidemiology, diagnostics, prevention, and management.