Phage therapy combined with Gum Karaya injectable hydrogels for treatment of methicillin-resistant Staphylococcus aureus deep wound infection in a porcine model.

Skin and soft tissue infections (SSTIs) represent a significant healthcare challenge, particularly in the context of increasing antibiotic resistance. This study investigates the efficacy of a novel therapeutic approach combining bacteriophage (phage) therapy with a gum Karaya (GK)-based hydrogel delivery system in a porcine model of deep staphylococcal SSTIs. The study exploits the lytic activity and safety of the Staphylococcus phage 812K1/420 of the Kayvirus genus, which is active against methicillin-resistant Staphylococcus aureus (MRSA). The GK injectable hydrogels and hydrogel films, developed by our research group, serve as effective, non-toxic, and easy-to-apply delivery systems, supporting moist wound healing and re-epithelialization. In the porcine model, the combined treatment showed asynergistic effect, leading to a significant reduction in bacterial load (2.5 log CFU/gram of tissue) within one week. Local signs of inflammation were significantly reduced by day 8, with clear evidence of re-epithelialization and wound contraction. Importantly, no adverse effects of the GK-based delivery system were observed throughout the study. The results highlight the potential of this innovative therapeutic approach to effectively treat deep staphylococcal SSTIs, providing a promising avenue for further research and clinical application in the field of infections caused by antibiotic-resistant bacteria.

Advantages of simultaneous radial nerve and tendon reconstruction - a case report.

Transection of the radial nerve is frequently associated with humeral shaft fractures that are part of a very complex upper extremity injury. In the presented case, a 19-year-old man with a 10-cm radial nerve defect with a need for nerve grafting to recover complete sensory and motor deficit of the radial nerve. In our case, at the same time we provided the tendon transfer of musculus (m.) pronator teres to m. extensor carpi radialis brevis, m. flexor carpi ulnaris to m. extensor digitorum communis, m. palmaris longus to m. extensor pollicis longus, and long sural nerve graft because of an extensive zone of the injury. The assumption was that if these two procedures are performed in one surgery, it will accelerate overall recovery, restore the functionality of the upper limb more quickly, and thus enable a faster recovery.

Cyanide poisoning in patients with inhalation injury - the phantom menace.

Inhalation injury is a serious complication in patients with burns that dramatically increases their morbidity and mortality. These patients are always suspected of having inhalation injury with potential intoxication. We usually encounter carbon monoxide intoxication, but it is necessary to think about the possibility of poisoning by other combustion products. Cyanide intoxications are less common, but their diagnosis and treatment are more complicated. The diagnosis can only be based on the history, clinical findings, and indirect laboratory signs. Direct determination of plasma cyanide levels is not generally adopted in routine clinical practice. Nowadays, several specific antidotes with different mechanisms of action are available. There are no clear guidelines on the antidote of choice, as the evidence base is limited by a lack of randomised controlled trials in humans. In two mini case reports, we present our experience with the diagnosis and therapy of patients with suspected cyanide poisoning.

SKIN SUBSTITUTES IN RECONSTRUCTION SURGERY: THE PRESENT AND FUTURE PERSPECTIVES.

The progress in critical and intensive care burn management in the 21st century has significantly reduced mortality in patients with critical burn injuries. This progress has moved the focus of burns care from simple survival to the quality of life after the burn trauma, in particular to healing of defects caused by full-thickness burns, subsequent maturation, characteristics and appearance of the scars. The benefits of the application of skin substitutes include elimination of excessive scarring, hypertrophic and keloid scar formation and subsequent contracture development. The authors of this article present the strategy of use, application and development of dermal scaffolds as well as the current trends in the use of dermal scaffolds in the treatment of full-thickness burns.

Rare Mucor circinelloides and Fusarium infection in latissimus free flap reconstruction after devastating foot injury in non-neutropenic patient.

Nowadays, free flap reconstruction in devastating lower limb trauma is a standard procedure in reconstructive surgery. The greatest factor directly affecting limb salvage is still the risk of infectious complications, whether local or systemic. Fungal wound infections are not among the most common infection complications in surgery, but their low incidence is compensated for by their fulminant and serious course, as well as severe local tissue destruction and strong angio-invasive potential together with the possibility of dissemination. In this case study, we present an example of a devastating lower leg injury, solved using latissimus free flap reconstruction, with subsequent difficult and prolonged healing, due to an invasive filamentous fungi infection. In the final part of the article, we focus briefly on the occurrence of similar cases in the literature.

USE OF MEDIAL FEMORAL CONDYLE FLAP AND ANTEROLATERAL THIGH FREE FLAP IN PROXIMAL TIBIAL POSTTRAUMATIC NON-UNION WITH MULTIPLE ANASTOMOSIS - CASE REPORT.

Fractures of the proximal tibia are high energy fractures. According to available literature, 3-4% of all fractures heal problematically with non-union or osteomyelitis. Usage of locking compression plating system as well as usage of hybrid fixator is associated with the risk of compartment syndrome, local infection and subsequent malunion, osteomyelitis or non-union. We present a case of 30-year-old male suffering from posttraumatic non-union. The medial femoral condyle flap was selected due to its favourable properties providing a highly vascularised osteogenic tissue in combination with anterolateral thigh flap and Corlett loop. Our case report describes a reconstruction of a long weight-bearing bone. Despite the amount of anastomoses and usage of vein graft, the selected method of reconstruction seems to be safe and with a long-lasting benefit for the patient.

[Our Experience with Application and Cutometric Evaluation of Collagen-Elastin Dermal Substitute Matriderm® in Local Therapy of 6-Year-Old Boy with Severe Burn Trauma]. / Nase zkusenosti s vyuzitím dermální náhrady na bázi kolagen-elastinové matrix Matriderm ® v terapii tezkých popálenin u sestiletého chlapce.

The consequences of deep burns to the hands and face are the most challenging we encounter in modern reconstructive surgery. In many cases, the simple autotransplantation of full-thickness defects with split-thickness skin grafts is now considered inadequate or outdated. For this and many other reasons, the use of dermal substitution is on the rise as it provides improved cosmetic effects and skin compliance, reduces contractility and greatly approximates the histological image to normal, healthy skin. For the purpose of this article, we present a dermal substitution, Matriderm ® , in the case of extensive thermal trauma in a 6-year-old boy. Key words:dermal substitution, burns, Matriderm ® , cutometry.

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part I: Epidemiology and general microbiological characteristics.

INTRODUCTION: Toxic epidermal necrolysis (TEN) is a rare, life-threatening autoimmune disease predominantly manifested in the skin and mucous membranes. Today, infectious complications have the dominant share in mortality of TEN patients. Due to the nature of the therapy and administration of immunosuppressive medications, a wide range of potentially pathogenic microorganisms, which cause infectious complications in different compartments in these patients, is not surprising. MATERIAL AND METHODOLOGY: This is a multicentric study, which included all patients with TEN hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area was over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the registry CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation), when specific parameters relating to epidemiological indicators and infectious complications in patients with TEN were evaluated in the form of a retrospective analysis. RESULTS: In total, 39 patients with TEN were included in the study (12 patients died, mortality was 31%), who were hospitalized in the monitored period. The median age of patients in the group was 63 years (the range was 4-83 years, the mean was 51 years), the median of the exfoliated area was 70% TBSA (total body surface area) (range 30-100%, mean 67%). SCORTEN was calculated for 38 patients on the day of admission. Its median in all patients was 3 (range 1-6; mean 3). Any kind of infectious complication in the study group was recorded in 33 patients in total (85%). In total, 30 patients (77%) were infected with gram-positive cocci, 27 patients (69%) with gram-negative rods, and yeast cells or fibrous sponge were cultivated in 12 patients (31%). A total of 32 patients (82%) were found to have infectious complications in the exfoliated area, 15 patients (39%) had lower respiratory tract infections, 18 patients (46%) urinary tract infections and 15 patients (39%) an infection in the bloodstream. The most common potentially pathogenic microorganism isolated in our study group was coagulase neg. Staphylococcus, which caused infectious complications in 24 patients. Enterococcus faecalis/faecium (19 patients), Pseudomonas aeruginosa (17 patients), Staphylococcus aureus (11 patients) and Escherichia coli (11 patients) were other most frequently isolated micro-organisms. CONCLUSION: The published data were obtained from the unique registry of TEN patients in Central Europe. In the first part, we have succeeded in defining the basic epidemiological indicators in the group of patients anonymously included in this registry. The study clearly confirms that infectious complications currently play an essential role in TEN patients, often limiting the chances of survival. The study also shows a high prevalence of these complications in the period after 15days from the start of hospitalization, when most patients already have completely regenerated skin cover.

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part II: Specific systemic and local risk factors for the development of infectious complications.

The aim of the study was to identify the most important systemic and local risk factors for the development of infectious complications in patients with toxic epidermal necrolysis (TEN). MATERIAL AND METHODOLOGY: This is a multicentric study that included all patients with TEN who were hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area included a population of over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation) registry, wherein specific parameters related to epidemiological indicators and infectious complications in patients with TEN were evaluated as a retrospective analysis. RESULTS: A total of 38 patients (97%) of the group were treated with corticosteroids. The comparison of patients with different doses of corticosteroids did not exhibit a statistically significant effect of corticosteroid administration on the development of infectious complications (p=0.421). There was no effect of the extent of the exfoliated area on the development of infectious complications in this area. The average extent of the exfoliated area was 66% TBSA (total body surface area) in patients with reported infectious complications and 71% TBSA (p=0.675) in patients without infectious complications. In the case of the development of an infectious complication in the bloodstream (BSI), the increasing effect of the SCORTEN (SCORe of Toxic Epidermal Necrosis) value was monitored during hospitalization. Within 5days from the beginning of the hospitalization, the average SCORTEN value was 2.7 in 6 patients with BSI and 3.0 in 32 patients without BSI (p=0.588). In the period after the 15th day of hospitalization, 7 patients with BSI had an average SCORTEN value of 3.4, and 16 patients without BSI had an average SCORTEN value of 2.5 (p=0.079). In the case of low respiratory tract infection (LRTI), the effects of the necessity for artificial pulmonary ventilation and the presence of tracheostomy were monitored. The statistically significant effect of mechanical ventilation on the development of LRTI occurred only during the period of 11-15days from the beginning of the hospitalization (p=0.016). The effect of the tracheostomy on the development of LRTI was proven to be more significant. CONCLUSION: We did not find any statistically significant correlation between the nature of immunosuppressive therapy and the risk of developing infectious complications. We failed to identify statistically significant risk factors for the development of BSI. Mechanical ventilation and tracheostomy increase the likelihood of developing LRTIs in patients with TEN.

OLEOGEL-S10 TO ACCELERATE HEALING OF DONOR SITES: MONOCENTRIC RESULTS OF PHASE III CLINICAL TRIAL.

MATERIAL AND METHODS: Oleogel-S10, an ointment containing betulin-rich triterpene dry extract from birch bark was tested in an open, blindly evaluated, prospective, controlled, randomized multicentre study to improve wound healing in donor sites. The primary endpoint was time to wound closure, and secondary endpoints were scar related measurements at the time of wound closure, and 3 and 12 months after wound closure (POSAS, laser speckle contrast analysis, viscoelastic analysis). RESULTS: We report the results from a single centre (Department of Burns and Reconstructive Surgery, University Hospital Brno) of this phase III clinical trial. A total of 32 patients (25 men and 7 women) were included with the mean patient age of 41.8 years (SD, ±11.66). The mean extent of patients donor sites in the study was 56.77cm2 (SD, ±20.39). Median healing time of the verum group (Oleogel-S10) was 7 days (95% Confidence Interval 7-8 days) and for controls 8 days (95% CI 7-10 days). Comparison of POSAS data from the verum group revealed significantly lower values at all three time points as compared to the controls. Perfusion of scars of the verum group reached on average of 115 perfusion units at the end of treatment; the average was 69.8 perfusion units at the 3-month follow-up and 50.2 perfusion units at the 12-month follow-up. Control sites displayed significantly higher values at all time points (122.2 perfusion units, 73.9 perfusion units, 52.2 perfusion units). Significant differences were detected in the skins viscoelastic properties, with sites treated with Oleogel-S10 displaying more favourable values. CONCLUSION: In our results, we demonstrate the significant effectiveness of Oleogel-S10 in donor sites healingKeywords: Donor site, Triterpenes, Oleogel-S10, wound closure.

Antimicrobial effect of novel hydrogel matrix based on natural polysaccharide Sterculia urens.

INTRODUCTION: Materials for modern wound-management are a very broad and heterogeneous group. One of the most important representatives is natural materials, or more precisely polysaccharides isolated from various plants and animals. With the increasing resistance of pathogens to established antimicrobial agents, there is also an attempt to discover new mechanisms of the effects of these materials. Gum karaya (GK) is a very promising representative of the natural polysaccharides group and, since it is obtained from Sterculia urens as resin, it is also possible to assume its certain antimicrobial activity. MATERIAL AND METHODOLOGY: The antimicrobial potential of GK and chitosan (Ch) has been tested on several preselected strains to match the real epidemiological situation of the agents of infectious complications in the field of burned wounds. Tested strains included representatives of gram-positive and gram-negative bacteria as well as selected yeasts. Methicillin susceptible Staphylococcus aureus CCM 4223 (ATCC 29213), methicillin resistant Staphylococcus aureus CCM 4750 (ATCC 43300), Klebsiella pneumoniae CCM 4985 (ATCC 700603), Candida albicans CCM 8261 (ATCC 90028), Pseudomonas aeruginosa CCM 3955 (ATCC 27853) were obtained from the Czech Collection of Microorganisms. Pseudomonas aeruginosa FF 1, Pseudomonas aeruginosa FF 2 and Pseudomonas aeruginosa FF 3 (all multi-resistant clinical strains), Staphylococcus epidermidis A 013, Staphylococcus epidermidis A 117, and Candida parapsilosis BC 11 were obtained from the Collection of Microorganisms at the St. Annes University Hospital, Brno. Antimicrobial tests were performed using the disk diffusion test methodology. Another set of antimicrobial tests was obtained by measuring the growth curves. RESULTS: Bacteriostatic activity testing showed 1% GK concentration and both 1% and 0.5% chitosan concentration effective against all pathogens tested. The combination of GK50/Ch50 in concentrations of 1% and 0.5% had similar or better effect. Lower concentrations of the combined material are poorly effective against tested strains. Bactericidal activity testing has not produced positive results, except for Candida spp., where only a partial effect of GK50/Ch50 was observed at 1% concentration. In the growth curve test, the efficiency of both GK alone and chitosan was found to be significantly higher in gram-positive bacteria compared to gram-negative ones. In the case of this experiment, only a one-tenth concentration was used compared to the disk diffusion test concentration. This results correspond with the data from the bacteriostatic activity testing. CONCLUSION: This is the first publication that attempts to comprehensively define the potential for GK antimicrobial activity and also the possible potentiation of this activity with the use of chitosan. Further experiments are needed to extend the antimicrobial efficiency to gram-negative bacteria.

MICROMYCETES INFECTION IN PATIENTS WITH THERMAL TRAUMA.

GOAL: Determination of basic epidemiological parameters of burn patients with micromycetes infection. Identification of the most important micromycetes in burn patients. MATERIAL AND METHODS: Monocentre retrospective study enrolling all adult burn patients who were hospitalized between 2007 and 2015 and in whom micromycetes were isolated during hospitalization. ABSI index (Abbreviated Burn Severity Index) was used to evaluate severity of thermal trauma. Results were statistically analysed. RESULTS: There were 61 patients with thermal trauma identified in total during the period of observation, and there were yeast or fibrous fungi isolated. There were 37 males and 24 females (M:F ratio - 1.5:1) in this group. The average age of patients was 57.3 years (29 patients were aged up to 60 years, 32 patients were over the age of 60 years, inclusive). 6 patients died (lethality was 9.8%). The average extent of the burn area was 21.6% TBSA (median 14.0%). There were 90 strains of micromycetes cultured in total in these patients (79 yeasts, 11 fibrous fungi). Micromycetes were isolated from burn area in 30 patients, from the lower airways in 19 patients, from the urogenital area in 15 patients and from blood culture in 7 patients. Non-albicans Candida species were predominant among yeasts (60 strains); Candida albicans was isolated 16 times in total. Aspergillus fumigatus (4 isolations) and Fusarium species (2 isolations) were predominant species among fibrous fungi. CONCLUSION: We successfully identified the basic epidemiological parameters in burn patients with micromycetes infection, similarly to the most important yeasts and fibrous fungi causing infection in these patients.

[The correlation of results of breath analysers and laboratory blood examinations of blood-ethanol concentration (Czech and Slovak study)]. / Mezirepubliková Cesko-Slovenská studie korelace výsledku dechových analyzátoru a výsledku laboratorní analýzy pri zjistování hladiny alkoholu v krvi.

The target of this study was to compare the results of breath analysers and "lege artis" laboratory blood examinations when determining alcohol levels. This was then used to determine whether any differences exist between the two methods, and how large these differences are. 610 cases from 11 workplaces in the Czech Republic and Slovakia were analysed. The type of breath analyser was not taken into consideration. All cases had to be in the elimination phase. Difference of time between breath test and blood test were rectified through the use of reverse recomputation. It was detected that only 20.8% of the results of respiratory analyser tests correspond to the detected real alcohol level in blood. The maximum difference when a respiratory analyser measured more than a blood test was 1.34 g x kg(-1). and the maximum difference when the analyse measured less was 1.86 g x kg(-1).

Blood, sweat and fear. "A classification of hematidrosis".

In order to verify the accuracy of the commonly used statement, "I sweat blood," a survey of the literature in the subject of hematidrosis was made. Seventy-six cases were studied and classified into categories according to the causative factor. These were, component of systemic disease, vicarious menstruation, excessive exertion, psychogenic, and unknown. The psychogenic were further subdivided into those that occurred only one time, those that recurred and the stigmatics. Acute fear and intense mental contemplation were found to be the most frequent inciting causes. Hematidrosis is an extremely rare clinical phenomenon with only few instances reported to have occurred within the twentieth century.

Execution by crucifixion. History, methods and cause of death.

Crucifixion, as a method of execution was practiced in many cultures before it was outlawed in the Roman Empire by Constantine in 341 C.E., but it has been used sporadically since then. Recent archeological excavations of the remains of a crucified victim have stimulated studies of the methods used. The theories regarding the cause of death as reported in the medical literature are discussed.

Small-angle light scattering from an anisotropic sphere in the Rayleigh-Gans-Debye approximation: the Mueller matrix formalism.

An explicit form of the Mueller matrix is given for an anisotropic sphere fulfilling the requirements of the Rayleigh-Gans-Debye (RGD) approximation. The angular dependences of single matrix elements are compared with Lorenz-Mie predictions for an isotropic sphere. Good agreement between the Lorenz-Mie model and that of RGD is observed where the latter is applicable. The magnitude and sign of the matrix elements depend on the size parameter kR (k = 2pi/lambda;R is the radius of the sphere) as well as on the magnitude and sign of the (ñ - 1)/Deltan parameter, where ñ is the relative refractive index and Deltan is the relative anisotropy of the sphere.