A Digital Tool for Measuring Healing of Chronic Wounds Treated with an Antioxidant Dressing: A Case Series.

(1) Abstract: Wound monitoring is an essential aspect in the evaluation of wound healing. This can be carried out with the multidimensional tool HELCOS, which develops a quantitative analysis and graphic representation of wound healing evolution via imaging. It compares the area and tissues present in the wound bed. This instrument is used for chronic wounds in which the healing process is altered. This article describes the potential use of this tool to improve the monitoring and follow-up of wounds and presents a case series of various chronic wounds with diverse etiology treated with an antioxidant dressing. (2) Methods: A secondary analysis of data from a case series of wounds treated with an antioxidant dressing and monitored with the HELCOS tool. (3) Results: The HELCOS tool is useful for measuring changes in the wound area and identifying wound bed tissues. In the six cases described in this article, the tool was able to monitor the healing of the wounds treated with the antioxidant dressing. (4) Conclusions: the monitoring of wound healing with this multidimensional HELCOS tool offers new possibilities to facilitate treatment decisions by healthcare professionals.

Prevalence of overweight and obesity in Aragón and variations according to health determinants.

INTRODUCTION: Childhood obesity is a serious global health problem that is continuously increasing worldwide. Many studies suggest that socioeconomic factors are related to the development of obesity. The objective of our study was to analyse the prevalence of overweight and obesity in Aragón, calculated applying the World Health Organization (WHO) growth standards, and to study its association with socioeconomic factors. MATERIAL AND METHODS: We collected data for the entire paediatric population of Aragón aged 2-14 years. We classified each child as normal weight, overweight or obese based on the body mass index. We calculated prevalences by province and basic health care zone. To analyse differences in relation to social inequalities, we used the Aragón deprivation index as an indicator of socioeconomic status. RESULTS: The final sample consisted of 161 335 children aged 2-14 years, 51% male and 49% female. The overall prevalence of excess weight was 31.1% (17.7% overweight and 13.3% obesity) and was significantly higher in boys. We found a high frequency of under-recording in health records (65%). There was a direct association between the deprivation index and the prevalence of obesity and overweight throughout Aragón, with a significant strong correlation in urban areas, where socioeconomic factors explained up to 66.4% of obesity and 48.9% of body weight excess. CONCLUSIONS: In Aragón, the prevalence of obesity and excess weight is high and associated with low family socioeconomic status.

[Optimize maternal and neonatal health from health education. Literature review.] / Optimizar la salud materna y neonatal desde la educación sanitaria. Revisión de la literatura.

OBJECTIVE: Pregnancy is an event in a woman's life with enormous potential to affect her health and the newborn health. The objective of this review was to study the contributions made by the different investigations on nutrition and physical activity (PA) in relation to obstetric and perinatal outcomes, as well as health status in adulthood from 2011 to 2021. METHODS: An exploratory review of the literature was carried out. Two blind reviewers performed the search, screening and inclusion of the articles (37). RESULTS: Bibliographic reviews (35.13%) and descriptive studies (21.6%) were collected. The extracted information was grouped into three thematic areas: health education (HE) (16 articles), diet (12 articles), physical activity (9 articles) and 4 sub-themes: macronutrients; micronutrients; type of exercise and intensity and frequency of exercise. The most reported obstetric and perinatal outcomes were premature birth (37.5%), fetal growth disturbance (37.5%) and gestational diabetes mellitus (GDM) (25%). CONCLUSIONS: Results are in line with the published literature. Diet and PA play a relevant role in obstetric and perinatal outcomes, as well as in health status in adulthood. However, it's not clear which is the best educational intervention to improve adherence to a healthy lifestyle during and after pregnancy. This review may have incurred several biases including publication bias and selection bias. Future research on HE in pregnancy should adopt an approach focused on educational interventions that achieve greater adherence to a healthy lifestyle.

OBJETIVO: La gestación es un acontecimiento en la vida de la mujer con un enorme potencial para incidir en la salud de la misma y del neonato. El objetivo de esta revisión fue estudiar las aportaciones realizadas por las distintas investigaciones sobre alimentación y actividad física (AF) en relación a los resultados obstétricos y perinatales, así como en el estado de salud en la edad adulta desde el año 2011 hasta 2021. METODOS: Se realizó una revisión exploratoria de la literatura. Dos revisores ciegos realizaron la búsqueda, cribado e inclusión de los artículos (37). RESULTADOS: Se cotejaron revisiones bibliográficas (35,13%) y estudios descriptivos (21,6%). La información se agrupó en tres áreas temáticas: educación sanitaria (ES) (16), alimentación (12), actividad física (9) y cuatro subtemas: macronutrientes; micronutrientes; tipo de ejercicio; intensidad y frecuencia. Las complicaciones más reportadas fueron: parto prematuro (37,5%), alteración del crecimiento fetal (37,5%) y diabetes mellitus gestacional (DMG) (25%). CONCLUSIONES: Los resultados coinciden con la literatura publicada. La alimentación y la AF tienen un papel relevante en los resultados obstétricos y perinatales, así como en el estado de salud en la edad adulta. No obstante, no queda clara cuál es la mejor intervención educativa para mejorar la adherencia a un estilo de vida saludable durante el embarazo y posterior a este. Esta revisión puede haber incurrido en varios sesgos, entre los que están el de publicación y el de selección. La investigación futura sobre la ES en la gestación debe adoptar un enfoque centrado en las intervenciones educativas que consigan una mayor adherencia a un estilo de vida saludable.

Chromatographic measurement of 3-hydroxyanthranilate 3,4-dioxygenase activity reveals that edaravone can mitigate the formation of quinolinic acid through a direct enzyme inhibition.

Herein it is reported the development and application of two chromatographic assays for the measurement of the activity of 3-Hydroxyanthranilate-3,4-dioxygenase (3HAO). Such an enzyme converts 3-Hydroxyanthranilic acid (3HAA) to 2-amino-3-carboxymuconic semialdehyde (ACMS), which undergo a spontaneous, non-enzymatic cyclization to produce quinolinic acid (QUIN). The enzyme activity was measured by quantitation of the substrate consumption over time either with spectrophotometric (UV) or mass spectrometric (MS) detection upon reversed-phase chromatographic separation. MS detection resulted more selective and sensitive, but less accurate and precise. However, both methods have sufficient sensitivity to allow the measurement of enzyme activity with consistent results compared to literature data. Since MS detection allowed less sample consumption it was used to calculate the kinetics parameters (i.e., Vmax and Kd) of recombinant 3HAO. Another MS-based method was then developed to measure the amount of QUIN produced, revealing an incomplete conversion of 3HAA to QUIN. As suggested by previous studies, the enzyme activity was apparently sensitive to the redox state of the enzyme thiols. In fact, thiol reducing agents such as dithiothreitol (DTT) and glutathione (GSH), can alter the enzyme activity although the investigation on the exact mechanism involved in such effect was beyond the scope of the research. Interestingly, edaravone (EDA) induced an in vitro suppression of QUIN production through direct, competitive 3HAO inhibition. EDA is a molecule approved for the treatment of amyotrophic lateral sclerosis (ALS), a neurodegenerative disease associated with an increase of QUIN concentrations in both serum and cerebrospinal fluid. Although EDA was reported to mitigate ALS progression its mode of action is still largely unknown. Some studies reported antioxidant and radical scavenger properties of EDA, but none confirm a direct activity as 3HAO enzyme inhibitor. Since QUIN is reported to be a neurotoxic metabolite, 3HAO inhibition can contribute to the beneficial effect of EDA in ALS, although such a mechanism must be then confirmed in vivo. However, EDA might be a convenient scaffold for the design of selective 3HAO inhibitors with potential applications in ALS treatment.

Drone Applications for Emergency and Urgent Care: A Systematic Review.

INTRODUCTION: In recent years, the use of drones in health emergencies has increased. Among their main benefits are avoiding endangering rescuers, travelling long distances in a short time, or contacting victims in risky situations; but despite their multiple advantages, their use has not been fully demonstrated. STUDY OBJECTIVE: This study aims to identify the available evidence on the use of drones in emergency health care compared to traditional health care. METHODS: Systematic review of the literature was conducted. Search protocols were developed to locate studies that met the established selection criteria. Six experimental or quasi-experimental studies with high methodological quality published from the beginning of indexing until 2020 were included. RESULTS: Drones covered a significantly larger area than other traditional tracking methods and were very useful for performing preliminary triage, determining needs, and knowing the scene prior to the arrival of rescuers. In addition, drones reduced the time required to locate the victim. CONCLUSIONS: Drones are an element to be taken into account when attending health emergencies as they significantly improve the distance travelled to locate accident victims, have the possibility of performing triage prior to the arrival of the health care units, and improve the time and quality of the care provided.

Dual Mobility Cups as the Routine Choice in Total Hip Arthroplasty.

Background and Objectives: Total hip arthroplasty (THA) is considered the most successful surgical procedure in orthopedics. However, dislocation remains the main indication for surgical revision. New designs of dual mobility cups (DMC) have lowered the classical complications and have extended the indications of DMC in elective surgeries. Our aim is to assess the trend of DMC indications in THA as well as the incidence of their dislocation. Materials and Methods: We retrospectively reviewed all patients undergoing THA with DMC during the years 2015 and 2021. The original indication for DMC included patients sustaining neck of femur fractures (NOF#) and associated risk factors for dislocations. Five years later, DMC was considered our standard of care in total hip arthroplasty. The approach (anterolateral or posterolateral) was chosen by the surgeon according to his/her preferences, as was the implant. Data collected included patients' demographics, diagnosis, admission time, surgical approach, cup models, and inclination and complications. Patients sustaining a hip dislocation were prospectively reviewed and assessed for treatment received, new dislocations, and need for surgical revision. Two groups were created for the analysis according to the presence or absence of dislocation during follow-up. Results: In the analysis, 531 arthroplasties were included (mean age 72.2 years) with a mean follow-up of 2.86 years. The trend of indications for DMC increased from 16% of THA in 2015 to 78% of THA in 2021. We found a total of 8 dislocations (1.5%), none of them associated with elective surgery. Closed reduction was unsatisfactory in four cases (50%). There was one case of intraprosthetic dislocation. Dislocations were associated to smaller heads (22 mm) (1.5% vs. 25%, p = 0.008) and cups (51.2 mm vs. 48.7 mm, p = 0.038) and posterior approach (62.5% vs. 37.5%, p = 0.011). Conclusion: Dual mobility cups are a great option to reduce the risk of dislocation after a THA both in the neck of femur fractures and elective cases. The use of an anterolateral approach in THA after a neck or femur fracture might considerably decrease the risk of dislocation.

Evaluation of Commercial Myxomatosis Vaccines against Recombinant Myxoma Virus (ha-MYXV) in Iberian Hare and Wild Rabbit.

The recent emergence of a new myxoma virus capable of causing disease in the Iberian hare (Lepus granatensis) has resulted in numerous outbreaks with high mortality leading to the reduction, or even the disappearance, of many local populations of this wild species in the Iberian Peninsula. Currently, the available vaccines that prevent myxomatosis in domestic rabbits caused by classic strains of myxoma virus have not been assessed for use in Iberian hares. The main objective of this study was to evaluate the efficacy of commercial rabbit vaccines in Iberian hares and wild rabbits against the natural recombinant myxoma virus (ha-MYXV), bearing in mind its application in specific scenarios where capture is possible, such as genetic reserves. The study used a limited number of animals (pilot study), 15 Iberian hares and 10 wild rabbits. Hares were vaccinated with Mixohipra-FSA vaccine (Hipra) and Mixohipra-H vaccine (Hipra) using two different doses, and rabbits were vaccinated with the Mixohipra-H vaccine or the Nobivac Myxo-RHD PLUS (MSD Animal Health) using the recommended doses for domestic rabbits. After the vaccination trials, the animals were challenged with a wild type strain of ha-MYXV. The results showed that no protection to ha-MYXV challenge was afforded when a commercial dose of Mixohipra-FSA or Mixohipra-H vaccine was used in hares. However, the application of a higher dose of Mixohipra-FSA vaccine may induce protection and could possibly be used to counteract the accelerated decrease of wild hare populations due to ha-MYXV emergence. The two commercial vaccines (Mixohipra-H and Nobivac Myxo-RHD PLUS) tested in wild rabbits were fully protective against ha-MYXV infection. This knowledge gives more insights into ha-MYXV management in hares and rabbits and emphasises the importance of developing a vaccine capable of protecting wild populations of Iberian hare and wild rabbit towards MYXV and ha-MYXV strains.

The Role of Antioxidants on Wound Healing: A Review of the Current Evidence.

(1) Background: Reactive oxygen species (ROS) play a crucial role in the preparation of the normal wound healing response. Therefore, a correct balance between low or high levels of ROS is essential. Antioxidant dressings that regulate this balance are a target for new therapies. The purpose of this review is to identify the compounds with antioxidant properties that have been tested for wound healing and to summarize the available evidence on their effects. (2) Methods: A literature search was conducted and included any study that evaluated the effects or mechanisms of antioxidants in the healing process (in vitro, animal models or human studies). (3) Results: Seven compounds with antioxidant activity were identified (Curcumin, N-acetyl cysteine, Chitosan, Gallic Acid, Edaravone, Crocin, Safranal and Quercetin) and 46 studies reporting the effects on the healing process of these antioxidants compounds were included. (4) Conclusions: this review offers a map of the research on some of the antioxidant compounds with potential for use as wound therapies and basic research on redox balance and oxidative stress in the healing process. Curcumin, NAC, quercetin and chitosan are the antioxidant compounds that shown some initial evidence of efficacy, but more research in human is needed.

Development of the Aerial Remote Triage System using drones in mass casualty scenarios: A survey of international experts.

The use of drones for triage in mass-casualty incidents has recently emerged as a promising technology. However, there is no triage system specifically adapted to a remote usage. Our study aimed to develop a remote triage procedure using drones. The research was performed in three stages: literature review, the development of a remote triage algorithm using drones and evaluation of the algorithm by experts. Qualitative synthesis and the calculation of content validity ratios were done to achieve the Aerial Remote Triage System. This algorithm assesses (in this order): major bleeding, walking, consciousness and signs of life; and then classify the injured people into several priority categories: priority 1 (red), priority 2 (yellow), priority 3 (green) and priority * (violet). It includes the possibility to indicate save-living interventions to injured people and bystanders, like the compression of bleeding injuries or the adoption of the recovery position. The Aerial Remote Triage System may be a useful way to perform triage by drone in complex emergencies when it is difficult to access to the scene due to physical, chemical or biological risks.

Validation of the Pressure Injury Prevention Knowledge questionnaire in nursing students: Rasch analysis. / Validación del cuestionario de Conocimientos sobre prevención de lesiones por presión en estudiantes de Enfermería: análisis Rasch.

OBJECTIVE: The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries. METHOD: A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables. RESULTS: The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme. CONCLUSIONS: The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%.

Development and validation of the Pressure Injury Prevention Barriers questionnaire in hospital nurses in Spain.

OBJECTIVE: To develop and validate a new questionnaire to measure the nurses' perceptions of the barriers towards the prevention of pressure injuries (PIs) at hospitals. DESIGN: Validation study with mixed methods. SETTING: Four university hospitals in southern Spain. PARTICIPANTS: The questionnaire was developed based on a literature review. A panel of 14 wound care experts rated the content validity. A sample of 438 nurses (registered nurses and assistant nurses) participated in the survey. MAIN OUTCOME MEASURES: The psychometric properties of the Pressure Injury Prevention Barriers (PIPB) questionnaire evaluated were: content validity, internal consistency reliability and construct validity. RESULTS: The final version of the questionnaire has 25 items grouped into four factors (management and organisation, motivation and priority, knowledge, and staff and collaboration). The confirmatory factor analysis showed good fit and error indices for the model (Comparative Fit Index=0.92, root mean square error of approximation=0.074). Cronbach's alpha was 0.90 (overall), and 0.89 (factor 1), 0.75 (factor 2), 0.72 (factor 3) and 0.45 (factor 4). Construct validity was good, demonstrated by the expected association with the scores on patient safety culture and on considering PIs as an adverse effect of hospital stay, but not with attitude score. CONCLUSION: The PIPB questionnaire is an instrument useful for measuring nurses' perceptions of the barriers to PIs prevention. The initial evidence shows that the questionnaire has good content validity, internal consistency and adequate construct validity. Relevance and comprehensiveness need to be assessed in further studies. It can be used both in research and in the evaluation of clinical settings to implementation of PIs preventive programmes in hospitals.

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument.

The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach's alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.

Antioxidant dressing therapy versus standard wound care in chronic wounds (the REOX study): study protocol for a randomized controlled trial.

BACKGROUND: A wound that does not heal in the orderly stages of the healing process or does not heal within 3 months is considered a chronic wound. Wound healing is impaired when the wound remains in the inflammatory stage for too long. A range of factors can delay the healing process: imbalance between proteases and protease inhibitors in the wound bed; bacterial colonization and the presence of biofilm; and oxidative stress. Recently, wound management has improved significantly. A new antioxidant dressing has been developed, which combines an absorbent matrix obtained from locust bean gum galactomannan and a hydration solution with curcumin and N-acetylcysteine. This dressing combines the advantages of moist healing in exudate management and free radical neutralization, achieving wound reactivation. The primary aim of this study is to compare the effect of the antioxidant dressing on chronic wound healing against the use of a standard wound dressing in patients with hard-to-heal wounds. METHODS: We will conduct a multicentre, single-blind, randomized controlled trial with parallel groups. Participants will be selected from three primary public health care centres located in Andalucía (southern Spain). Patients will be randomized into an intervention group (antioxidant dressing) or a control group (standard wound dressing). Assessments will be carried out at weeks 2, 4, 6 and 8. Follow-up will be for a period of 8 weeks or until complete healing if this occurs earlier. DISCUSSION: The findings from this study should provide scientific evidence on the efficacy of the antioxidant dressing as an alternative for the treatment of chronic wounds. This study fills some of the gaps in the existing knowledge about patients with hard-to-heal wounds. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03934671. Registered on 2 May 2019.

Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses.

Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.

Falls prevention strategies for patients over 65 years in a neurology ward: a best practice implementation project.

OBJECTIVES: The aim of this project was to promote evidence-based practice with regard to fall prevention and management, by implementing the recommendations from the best available evidence to reduce fall rates. INTRODUCTION: Falls are a main cause of disability in older people and the most common adverse event in all hospital patients. It is essential to implement the recommendations from evidence-based interventions to reduce these events. METHODS: A pre and post implementation audit method was used in a neurology ward, which employed the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research Into Practice (GRiP) module. The 15-month project evaluated between 20-30 patients from a sample at each audit (baseline in April 2016 and during three follow-up cycles in December 2016, March 2017 and June 2017). The data were inputted into an informatics system from nursing records and audited according to evidence-based processes and outcomes criteria. RESULTS: The baseline outcomes identified five barriers: incomplete fall registration, lack of an established fall prevention protocol for at-risk patients, limited knowledge about the fall prevention protocol, lack of a fall risk assessment scale and lack of multifactorial individual plans for fall prevention. Strategies were carried out and implemented following GRiP and all the criteria improved from baseline. CONCLUSIONS: The project successfully increased evidence-based practice on falls and provided mechanisms for sustaining evidence-based practice changes. Further audits are needed to improve some outcomes.

Enhanced brain-derived neurotrophic factor delivery by ultrasound and microbubbles promotes white matter repair after stroke.

Ultrasound-targeted microbubble destruction (UTMD) has been shown to be a promising tool to deliver proteins to select body areas. This study aimed to analyze whether UTMD was able to deliver brain-derived neurotrophic factor (BDNF) to the brain, enhancing functional recovery and white matter repair, in an animal model of subcortical stroke induced by endothelin (ET)-1. UTMD was used to deliver BDNF to the brain 24 h after stroke. This technique was shown to be safe, given there were no cases of hemorrhagic transformation or blood brain barrier (BBB) leakage. UTMD treatment was associated with increased brain BDNF levels at 4 h after administration. Targeted ultrasound delivery of BDNF improved functional recovery associated with fiber tract connectivity restoration, increasing oligodendrocyte markers and remyelination compared to BDNF alone administration in an experimental animal model of white matter injury.

Preparation and biological evaluation of (99m)Tc-labelled phenazine dioxides as potential tracers for hypoxia imaging.

The aim of this study was to investigate the capability of phenazine dioxides, recognized bioreductive antitumour agents, as carriers for (99m)Tc in order to generate potential theranostic radiopharmaceuticals towards hypoxic solid tumours. Two different phenazine dioxides were used as ligands for the (99m)Tc-tricarbonyl core in order to prepare the potential radiopharmaceuticals. The main physicochemical and biological properties were evaluated. Biodistribution of the two radiotracers was studied at different time points after intravenous injection in tumour bearing animals. Both compounds were obtained in high yield and radiochemichal purity. They were stable in labelling milieu, in human plasma and in the presence of histidine. Biodistribution studies in mice were characterized by slow blood clearance and persistent liver uptake, results that correlate with the values of lipophilicities and protein binding. Both the complexes showed good tumour uptake, which remained constant during the studied period. Tumour/muscle ratios proved very favourable, comparable to those of FMISO in the same animal model. On the other hand, tumour/blood ratios were low due to high blood uptake. The use of phenazine dioxides as ligands for the preparation of potential (99m)Tc-radiopharmaceuticals towards solid tumours is possible since tumour uptake and retention are promising although high blood and liver uptake are drawbacks worth consideration.