Aloe vera and wound healing: a brief review

Abstract Aloe vera possesses a great therapeutic importance in traditional medicine. It has attracted the attention of modern medical fields due to its wide pharmacological applications. The bioactive substances in Aloe vera proved to have antioxidant, anti-inflammatory, antibacterial, and antiviral properties. Taken into our consideration the long history of clinical applications of Aloe vera in traditional medicine, especially for promoting the healing of cutaneous wounds with rare adverse effects, it provides a cheap alternative to many expensive synthetic drugs. Recent techniques in tissue engineering created novel scaffolds based on Aloe gel extracts for wound healing applications. Nonetheless, further guided researche is required to foster the development of Aloe vera based scaffolds for the benefit of worldwide populations. Here, I systemically summarize the main events following wounding and the mechanism of action of Aloe vera in promoting the healing process. I hope to provide a solid piece of information that might be helpful for designing new research studies into this topic.

The effects of methanol extract of Galium verum L on cardiac redox state in hypertensive rats

Abstract The aim of this study was to assess the effects of methanol extract of G. verum on redox status of isolated heart of spontaneously hypertensive rats after ischemia. Twenty-four Wistar albino rats were divided into three groups: untreated control rats and rats that received 125 and 250 mg/kg G. verum extract for 4 weeks per os. Index of lipid peroxidation (measured as TBARS) and parameters of antioxidative defence system such as level of reduced glutathione (GSH) and activities of catalase (CAT) and superoxide dismutase (SOD) were spectrophotometrically determined in heart homogenate. The index of lipid peroxidation in heart tissue was lower in both treated groups compared to the control group. On the other hand, the activity of SOD was significantly higher after consumption of both doses, while the activity of CAT was significantly higher only after treatment with a higher dose of extract. Based on our results we might conclude that 4-week treatment with methanol extracts of G. verum has the potential to modulate myocardial redox signaling after ischemia, thus significantly alleviating cardiac oxidative stress and exerting dose-dependent antioxidant properties. Future studies are certainly necessary to fully clarify the role of this plant species in myocardial I-R injury.

So you need a surgeon? Need for surgeon presence as an alternative metric to predict outcomes and assess triage in the pediatric trauma population.

BACKGROUND: Injury Severity Score (ISS) is the primary metric by which triage has been evaluated in trauma activations. We compared ISS to a previously described set of criteria defined as Need for Surgical Presence (NSP). We hypothesize that NSP may serve as a way to augment ISS in predicting mortality and assessing triage in pediatric trauma patients. METHODS: A total of 19,139 pediatric trauma patients in the 2016 National Trauma Quality Improvement Program Database (excluding transfers) had complete data for mortality, mode of transport, age, injury type, ISS, and NSP factors. NSP was defined as having one or more of the following: intubation, transfusion, operation for hemorrhage control/craniotomy, vasopressors, interventional radiology, spinal cord Injury, tube thoracostomy, emergency thoracotomy, intracranial pressure monitor, or pericardiocentesis. RESULTS: Overall mortality was 1.3% and 96% of all patients suffered blunt injury. A total of 2787 (14.6%) patients had an NSP indicator compared to 2036 (10.8%) with an ISS ≥16. NSP was noninferior to ISS in predicting mortality with the AUC of 0.91 (95% CI 0.89-0.92) and 0.90 (95% CI 0.88-0.92) respectively. CONCLUSION: NSP predicts mortality in pediatric trauma patients as well as ISS, and may compliment ISS. NSP status can be assigned shortly after patient arrival. Proper assessment of over and undertriage allows for optimal resource utilization by the medical facility and ultimately benefits the hospital, physician and patient. STUDY TYPE: Retrospective national dataset study. LEVEL OF EVIDENCE: Level II.

Classificação WifI: o novo sistema de classificação da Society for Vascular Surgery para membros inferiores ameaçados, uma revisão de literatura / WIfI classification: the Society for Vascular Surgery lower extremity threatened limb classification system, a literature review

Resumo A Society for Vascular Surgery propôs nova classificação para o membro inferior ameaçado, baseada nos três principais fatores influenciadores do risco de amputação do membro: ferida (Wound, W), isquemia (Ischemia, I) e infecção do pé (foot Infection, fI): a classificação WIfI. Esta abrange também os diabéticos, anteriormente excluídos do conceito de isquemia crítica do membro devido a seu quadro clínico complexo. O objetivo da classificação era fornecer estratificação de risco precisa e precoce ao paciente com membro inferior ameaçado; auxiliar no manejo clínico, permitindo comparar terapias alternativas; e predizer o risco de amputação em 1 ano e a necessidade de revascularização. O objetivo deste estudo é reunir os principais pontos abordados sobre a classificação WIfI no meio científico. A maior parte dos estudos de validação da classificação demonstram sua associação à predição de salvamento do membro, eventos de reintervenção, amputação e estenose, taxas de amputação maior e menor, sobrevida livre de amputação, e cicatrização de feridas.

Abstract The Society for Vascular Surgery has proposed a new classification system for the threatened lower limb, based on the three main factors that have an impact on limb amputation risk: Wound (W), Ischemia (I) and foot Infection ("fI") - the WIfI classification. The system also covers diabetic patients, previously excluded from the concept of critical limb ischemia because of their complex clinical condition. The classification's purpose is to provide accurate and early risk stratification for patients with threatened lower limbs; assisting with clinical management, enabling comparison of alternative therapies; and predicting risk of amputation at 1 year and the need for limb revascularization. The objective of this study is to collect together the main points about the WIfI classification that have been discussed in the scientific literature. Most of the studies conducted for validation of this classification system prove its association with factors related to limb salvage, such as amputation rates, amputation-free survival, prediction of reintervention, amputation, and stenosis (RAS) events, and wound healing.

Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011.

INTRODUCTION: Physical activity is known to prevent falls; however, use of widely available exercise programs for older adults, including EnhanceFitness and Silver Sneakers, has not been examined in relation to effects on falls among program participants. We aimed to determine whether participation in EnhanceFitness or Silver Sneakers is associated with a reduced risk of falls resulting in medical care. METHODS: A retrospective cohort study examined a demographically representative sample from a Washington State integrated health system. Health plan members aged 65 or older, including 2,095 EnhanceFitness users, 13,576 Silver Sneakers users, and 55,127 nonusers from 2005 through 2011, were classified as consistent users (used a program ≥2 times in all years they were enrolled in the health plan during the study period); intermittent users (used a program ≥2 times in 1 or more years enrolled but not all years), or nonusers of EnhanceFitness or Silver Sneakers. The main outcome was measured as time-to-first-fall requiring inpatient or out-of-hospital medical treatment based on the International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition and E-codes. RESULTS: In fully adjusted Cox proportional hazards models, consistent (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63-0.88) and intermittent (HR, 0.87; 95% CI, 0.8-0.94) EnhanceFitness participation were both associated with a reduced risk of falls resulting in medical care. Intermittent Silver Sneakers participation showed a reduced risk (HR, 0.93; 95% CI, 0.90-0.97). CONCLUSION: Participation in widely available community-based exercise programs geared toward older adults (but not specific to fall prevention) reduced the risk of medical falls. Structured programs that include balance and strength exercise, as EnhanceFitness does, may be effective in reducing fall risk.

Assessing the concordance of health and child protection data for 'maltreated' and 'unintentionally injured' children.

OBJECTIVES: To quantify the concordance of hospital child maltreatment data with child protection service (CPS) records, and identify factors associated with linkage. METHODS: Multivariable logistic regression analysis was conducted following retrospective medical record review and database linkage of 884 child records from 20 hospitals and the CPS in Queensland, Australia. RESULTS: Nearly all children with hospital assigned maltreatment codes (93.1%) had a CPS record. Of these, 85.1% had a recent notification. 29% of the linked maltreatment group (n=113) were not known to the CPS prior to the hospital presentation. Almost one third of children with unintentional injury hospital codes were known to the CPS. Just over 24% of the linked unintentional injury group (n=34) were not known to the CPS prior to the hospital presentation but became known during or after discharge from hospital. These estimates are higher than the 2006/2007 annual rate of 2.39% of children being notified to the CPS. Rural children were more likely to link to the CPS, and children were over three times more likely to link if the index injury documentation included additional diagnoses or factors affecting their health. CONCLUSIONS: The system for referring maltreatment cases to the CPS is generally efficient, although up to 1 in 15 children had codes for maltreatment but could not be linked to CPS data. The high proportion of children with unintentional injury codes who linked to CPS suggests that clinicians and hospital-based child protection staff should be supported by further education and training to ensure children at risk are being detected by the child protection system.

[New classifications for dressings and wound care]. / Nouvelles nomenclatures de pansements et soins de plaies.

The new classification relating to the refunding of dressings and compresses may result in nurses modifying their practices, as it fixes new rules determining the cover of these products by the state health insurance. Presentation of the new measures.

Hyperbaric oxygen therapy for chronic wounds.

Hyperbaric oxygen therapy continues to be discussed as another adjunctive therapy in the continuum of wound care. There is a dearth of evidence from randomized clinical trials on HBO therapy. For evidence-based practice, more randomized, controlled studies need to be conducted with HBO therapy to determine its efficacy in treating other chronic wounds besides those of patients with diabetes.

Hot tub, whirlpool, and spa-related injuries in the U.S., 1990-2007.

BACKGROUND: Recreational use of hot tubs, whirlpools, and spas has increased within the past 3 decades. Injuries due to hot tubs, whirlpools, and spas can affect people of all ages and can result in serious disabilities. PURPOSE: This study examines nonfatal hot tub, whirlpool, and spa-related injuries on a national level. METHODS: The National Electronic Injury Surveillance System database was used to examine cases of nonfatal hot tub, whirlpool, and spa-related injuries treated in U.S. emergency departments from January 1, 1990, through December 31, 2007. Analysis was conducted from November 2008 to March 2009. RESULTS: An estimated 81,597 patients, aged <1-102 years, were treated in U.S. emergency departments for hot tub, whirlpool, and spa-related injuries, with the number increasing 160% over the 18-year study period (p<0.001). Nearly 73% of injuries occurred in patients aged >or=17 years. Lacerations were the most common diagnosis (27.8%) and accounted for 58% of all head injuries. Slips and falls were the most common mechanism of injury (47.6%); were more likely to result in an injury to the trunk than other body parts (OR=2.49, 95% CI=1.83, 3.39); and were more likely to result in concussions and fractures/dislocations than any other diagnosis (OR=7.813, 95% CI=2.194, 27.823 and OR=3.017, 95% CI=2.057, 4.425, respectively). CONCLUSIONS: Given the increase in hot tub, whirlpool, and spa ownership and the 160% increase in injuries during the study period, more research is needed to identify the cause of the increase in hot tub, whirlpool, and spa-related injuries and what injury-prevention solutions and policies may be appropriate.

Avaliação dos efeitos clínicos da fototerapia em úlceras venosas / Evaluation of clinical effects of phototherapy in venous ulcers

As úlceras venosas são lesões do sistema tegumentar de difícil cicatrização. Essas lesões são freqüentes em pacientes portadores de insuficiência venosa crônica e representam cerca de 80 por cento das lesões ulcerativas em membros inferiores. O objetivo deste trabalho foi avaliar os efeitos da ledterapia sobre o processo de cicatrização de úlceras venosas crônicas em uma paciente do gênero feminino, portadora de insuficiência venosa. Os resultados mostraram que todas as lesões apresentaram sinais de cicatrização, com redução da área das feridas após a introdução da ledterapia, sugerindo que esse recurso foi eficaz em aprimorar o processo de cicatrização das úlceras venosas da participante deste caso.

The venous ulcers are lesions of cutaneous tissue very difficult to heal. These lesions are frequent in patients with chronic venous insufficiency and about 80 percent of ulcerated lesions are on lower limbs. The objective of this study was to evaluate the effects of LED therapy on healing process of chronic venous ulcers of a female patient with venous insufficiency. The results showed that all lesions showed signs of healing, with wounds area reduction after beginning LED therapy, suggesting that this action was effective in improving healing process of venous ulcers of the participant of this case study.

[Protocol for the evaluation and treatment of chronic wounds in the home care setting]. / Protocole pour l'évaluation et la prise en charge des plaies chroniques.

In 2001, it became evident that the domiciliary care nurses needed a tool to assist them in treating patients with chronic wounds. A protocol was therefore developed which could be used not only by the nurses but also by doctors and other health care professionals working in home care. As a parallel measure, a network of nurses specialised in wound care and available for advice and consultation was established.

Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases.

OBJECTIVE: The aim of this work was to identify clinical data indicative of the number of hyperbaric oxygen therapy HBO2 sessions that should be prescribed for adjuvant treatment of tissue injuries of differing severity. PATIENTS: A total of 1730 cases of patients treated with HBO2 using an open protocol (without a predetermined number of sessions) was examined in this study. METHOD: A retrospective study involving charts review was conducted. Severity had been previously determined for the treatment of acute (fasciitis, myositis, gangrene, contaminated/infected perineal or lower extremity traumatic injuries) or chronic (osteomyelitis, pressure sore, diabetic or ischemic ulcer) injuries. Only patients that met or exceeded the supposed effective minimal treatment doses (5 sessions for acute, 10 sessions for chronic injuries) were included in the present study. RESULTS: The data analysis included 1506 cases. These consisted of 1014 patients with acute injuries, who required 11 to 18 sessions (depending on injury severity), and 492 patients with chronic injuries, who required a greater (p < 0.001) number of sessions (approximately 30/patient, independent of injury severity). Global mortality was 79/1506 patients. CONCLUSION: These results seem to support the initial indication of 15 HBO2 sessions for the treatment acute injuries, and 30 for treatment of chronic injuries. Prospective studies may better determine the number of sessions for the treatment of different types of injuries.

Principles of basic wound evaluation and management in the emergency department.

The primary objectives of basic wound management center around promoting optimal wound healing and cosmesis. These objectives may be achieved through the systematic assessment, preparation, and repair of the laceration supplemented with appropriate patient care instructions. The meticulous and methodical management of traumatic wounds described in this article will assist the emergency physician in decreasing overall complication rates and help improve patient satisfaction.

Hyperbaric oxygen therapy in the treatment of open fractures and crush injuries.

This article focuses on the use of hyperbaric oxygen therapy (HBOt) in the treatment of open fractures and crush injuries. Based on the clinical evidence and cost analysis, medical institutions that treat open fracture and crush injuries are justified in incorporating HBOt as a standard of care. Both Medicare and Undersea and Hyperbaric Medical Society guidelines list crush injuries as an approved indication for HBOt. Emergency physicians should familiarize themselves with this emerging treatment modality because of their role in the early management of these injuries.

Noninvasive hemodynamic monitoring for combat casualties.

The aims of this study were to develop and to test a noninvasive hemodynamic monitoring system that could be applied to combat casualties to supplement conventional vital signs, to use an advanced information system to predict outcomes, and to evaluate the relative effectiveness of various therapies with instant feedback information during acute emergency conditions. In a university-run inner city public hospital, we evaluated 1,000 consecutively monitored trauma patients in the initial resuscitation period, beginning shortly after admission to the emergency department. In addition to conventional vital signs, we used noninvasive monitoring devices (cardiac index by bioimpedance with blood pressure and heart rate to measure cardiac function, arterial hemoglobin oxygen saturation by pulse oximetry to reflect changes in pulmonary function, and tissue oxygenation by transcutaneous oxygen tension indexed to fractional inspired oxygen concentration and carbon dioxide tension to evaluate tissue perfusion). The cardiac index, mean arterial pressure, pulse oximetry (arterial hemoglobin oxygen saturation), and transcutaneous oxygen tension/fractional inspired oxygen concentration were significantly higher in survivors, whereas the heart rate and carbon dioxide tension were higher in nonsurvivors. The calculated survival probability was a useful outcome predictor that also served as a measure of severity of illness. The rate of misclassification of survival probability was 13.5% in the series as a whole but only 6% for patients without severe head injuries and brain death. Application of noninvasive hemodynamic monitoring to acute emergency trauma patients in the emergency department is feasible, safe, and inexpensive and provides accurate hemodynamic patterns in continuous, on-line, real-time, graphical displays of the status of cardiac, pulmonary, and tissue perfusion functions. Combined with an information system, this approach provided an early outcome predictor and evaluated, with an objective individualized method, the relative efficacy of alternative therapies for specific patients.

Assessment and management of surgical wounds in clinical practice.

Successful nursing care of surgical wounds is dependent on the nurse's knowledge and understanding of normal wound healing physiology, the type of surgery performed, the method of closure and the optimal treatment of the resultant wound. Using this knowledge, nurses can provide a systematic and holistic patient assessment, and consider any potential wound-related complications.

Does the addition of glutamine to enteral feeds affect patient mortality?

OBJECTIVE: Studies have failed to consistently demonstrate improved survival in intensive care unit (ICU) patients receiving immune-modulating nutrient-enhanced enteral feeds when compared with standard enteral feeds. The objective was to study in a prospective fashion the effects of adding glutamine to standard or immune-modulated (supplemented with omega-3 fatty acids, beta-carotene, and amino acids such as glutamine and arginine) tube feeds. DESIGN: Prospective, unblinded study using sequential allocation. SETTING: A university surgical trauma ICU. PATIENTS: All surgical and trauma patients admitted to the surgical trauma ICU at a university hospital over a 3-yr period who were to receive enteral feeds (n = 185). INTERVENTIONS: Sequential assignment to three isocaloric, isonitrogenous diets was performed as follows: standard 1-kcal/mL feeds with added protein (group 1), standard feeds with the addition of 20-40 g/day (0.6 g/kg/day) glutamine (group 2), or an immune-modulated formula with similar addition of glutamine (group 3). The goal for all patients was 25-30 kcal/kg/day and 2 g/kg/day protein. MEASUREMENTS AND MAIN RESULTS: Patients were followed until discharge from the hospital. The primary end point was in-hospital mortality, and multiple secondary end points were recorded. In-hospital mortality for group 1 was 6.3% (four of 64) vs. 16.9% (ten of 59, p = .09) for group 2 and 16.1% (ten of 62, p = .09) for group 3. After controlling for age and severity of illness, the difference in mortality between patients receiving standard tube feeds and all patients receiving glutamine was not significant (p < or = .11). There were no statistically significant differences between the groups for secondary end points. CONCLUSIONS: The addition of glutamine to standard enteral feeds or to an immunomodulatory formula did not improve outcomes. These findings suggest that enteral glutamine should not be routinely administered to patients with surgical critical illness.

Wound healing.

Wound healing in orthopaedic care is affected by the causes of the wound, as well as concomitant therapies used to repair musculoskeletal structures. Promoting the health of the host and creating an environment to foster natural healing processes is essential for helping to restore skin integrity. Normal wound healing physiologic processes, factors affecting wound healing, wound classification systems, unique characteristics of orthopaedic wounds, wound contamination and drainage characteristics, and potential complications are important to understand in anticipation of patient needs. Accurate wound assessment and knowledge of nursing implications with specific wound care measures (cleansing, debridement, and dressings) is important for quality care. New technologies are enhancing traditional wound care measures with goals of effective comfortable wound care to promote restoration of skin integrity.

The management of lower extremity wounds complicated by acute arterial insufficiency and ischemia.

Although wound care therapy has made significant advances in the past several years, clinicians encounter dilemmas on a day-to-day basis. One of these dilemmas is managing ischemic wounds. Certain characteristics (ischemic appearance, a history of a lack of healing, physical examination that finds no pulses, or a transcutaneous oxygen evaluation to suggest tissue hypoxia) will identify the wound as hypoxic or related to arterial disease. The clinician faces several decisions: Should an arteriogram be performed? Should an MRI or ABIs be ordered? Is a vascular surgery consult necessary? In response to this area of diagnostic and management conflict, the authors developed an algorithm for the treatment of patients with ischemic wounds. This article addresses the management of wounds primarily caused by peripheral arterial occlusive disease and includes discussion of the initial wound care consult, the factors that identify and classify patients with arterial wounds, and a description of how transcutaneous oximetry is used to evaluate this subgroup of patients. In addition, the concept of the Vascular Center is introduced and explained, including arterial vascular consultation and evaluation, arterial vascular anatomy, and noninvasive vascular studies that are important tools in the Vascular Center, as well as endovascular interventions such as arteriography, angioplasty and arterial stenting. The basics of arterial revascularization, the use of hyperbaric oxygen therapy to manage the patients with ischemic wounds, and outcome data from a case study illustrating the management algorithm utilized at the authors' facility also are presented.