Genotype-phenotype associations in microtia: a systematic review.

BACKGROUND: Microtia is a congenital ear malformation that can occur as isolated microtia or as part of a syndrome. The etiology is currently poorly understood, although there is strong evidence that genetics has a role in the occurrence of microtia. This systematic review aimed to determine the genes involved and the abnormalities in microtia patients' head and neck regions. METHODS: We used seven search engines to search all known literature on the genetic and phenotypic variables associated with the development or outcome of microtia. The identified publications were screened and selected based on inclusion and exclusion criteria and assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tools. We found 40 papers in this systematic review with phenotypic data in microtia involving 1459 patients and 30 articles containing genetic data involved in microtia. RESULT: The most common accompanying phenotype of all microtia patients was external ear canal atresia, while the most common head and neck abnormalities were the auricular, mental, and oral regions. The most common syndrome found was craniofacial microsomia syndrome. In the syndromic microtia group, the most common genes were TCOF1 (43.75%), SIX2 (4.69%), and HSPA9 (4.69%), while in the non-syndromic microtia group, the most frequently found gene was GSC exon 2 (25%), FANCB (16.67%), HOXA2 (8.33%), GSC exon 3 (8.33%), MARS1 (8.33%), and CDT1 (8.33%). CONCLUSIONS: Our systematic review shows some genes involved in the microtia development, including TCOF1, SIX2, HSPA9, GSC exon 2, FANCB, HOXA2, GSC exon 3, MARS1, and CDT1 genes. We also reveal a genotype-phenotype association in microtia. In addition, further studies with more complete and comprehensive data are needed, including patients with complete data on syndromes, phenotypes, and genotypes.

Characteristics of Patients with Pressure Injuries in a COVID-19 Referral Hospital.

OBJECTIVE: This retrospective study aimed to describe the characteristics of patients treated at a COVID-19 referral hospital from March 2020 to June 2021 who experienced pressure injuries (PIs) either before or after admission. METHODS: The researchers collected and analyzed data on patients' demographic characteristics, symptoms, comorbidities, location and severity of PI, laboratory values, oxygen therapy, length of stay, and vasopressor use. RESULTS: During the study period, 1,070 patients were hospitalized for COVID-19 with varying degrees of severity, and 12 patients were diagnosed with PI. Eight (66.7%) of the patients with PI were men. The median age was 60 (range, 51-71) years, and half of the patients had obesity. Eleven of the patients with PI (91.4%) had at least one comorbid condition. The sacrum and gluteus were the two most commonly affected sites. Those with stage 3 PI had a substantially greater median d-dimer value (7,900 ng/mL) than patients with stage 2 PI (1,100 ng/mL). The average length of stay was 22 (range, 9.8-40.3) days. CONCLUSIONS: Health professionals should be aware of an increase in d-dimer in patients with COVID-19 and PI. Even though PIs in these patients might not result in mortality, an increase in morbidity can be avoided with the right care.

Pressure Injury Management in Critically Ill Patients with COVID-19 in a Makeshift Hospital in Indonesia: A Report of Two Cases.

ABSTRACT: Patients who are critically ill with COVID-19 need ventilation support in the ICU. However, ICU patients are at higher risk of developing a pressure injury (PI). Unfortunately, PI prevention is not optimally implemented in Indonesia, especially in the makeshift hospitals created during the COVID-19 pandemic. Here, the authors report two cases of critically ill patients with COVID-19 who developed large sacral PIs during hospitalization in a makeshift hospital in Indonesia. The first patient developed a stage 3, 7 × 7-cm sacral PI on the 14th day of hospitalization. The second patient developed a stage 4, 12 × 8-cm sacral PI on the 16th day of hospitalization. Both patients had elevated d-dimer levels and used a noninvasive ventilator for 1 week. The wounds were treated with surgical debridement, silver hydrogel dressing, and hydrocolloid dressing and complemented with static air mattress overlay. The authors recommend that in situations where there is a shortage of healthcare workers, the government should provide pressure-redistribution devices and silicone foam dressings for all critically ill patients to prevent PI development and lighten the workload of healthcare workers.

Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta-analysis of observational studies and randomised controlled trials.

The application of negative pressure wound therapy (NPWT) in cancer surgical wounds is still controversial, despite its promising usage, because of the risks of increased tumorigenesis and metastasis. This study aimed to review the risks and benefits of NPWT in surgical wounds with the underlying malignant disease compared with conventional wound care (CWC). The first outcome was wound complications, divided into surgical site infection (SSI), seroma, hematoma, and wound dehiscence. The secondary outcome was hospital readmission. We performed a separate meta-analysis of observational studies and randomised controlled trials (RCTs) with CI 95%. Thirteen observational studies with 1923 patients and seven RCTs with 1091 patients were included. NPWT group showed significant decrease in the risk of SSI (RR = 0.45) and seroma (RR = 0.61) in observational studies with P value <0.05, as well as RCTs but were not significant (RR = 0.88 and RR = 0.68). Wound dehiscence (RR = 0.74 and RR = 1.15) and hospital readmission (RR = 0.90 and RR = 0.62) showed lower risks in NPWT group but were not significant. Hematoma (RR = 1.08 and RR = 0.87) showed no significant difference. NPWT is not contraindicated in cancer surgical wounds and can be considered a beneficial palliative treatment to promote wound healing.