Comparing near infrared spectroscopy and transcutaneous oxygen measurement in hard-to-heal wounds: a pilot study.

OBJECTIVE: Oxygen plays an integral role in all phases of the wound healing process and tissue oxygenation is a key determinant of wound healing. A comprehensive evaluation of patients with hard-to-heal wounds must include measurement of oxygenation in and around the area of skin breakdown. The current gold standard, transcutaneous oxygen measurement (TCOM), has numerous drawbacks and as a result has fallen into disuse. METHOD: This study compared measurement of tissue oxygenation of near infrared spectroscopy (NIRS) with TCOM in patients with acute and hard-to-heal wounds. The Shapiro-Wilk test was used to evaluate the normality of the data. The level of agreement between NIRS and TCOM was determined using Bland-Altman analysis. The relationship between TCOM and NIRS was examined using Pearson correlation. RESULTS: A total of 24 observations were obtained from 10 patients using TCOM and NIRS. The weighted mean partial pressure of oxygen (pO2) in the study population was 39.54mmHg (8.96 standard deviation). Bland-Altman analysis showed that mean difference was positive (18.75), suggesting an overestimation of oxygen measurements using TCOM compared with NIRS. The oxygen levels measured by TCOM and NIRS showed a strong correlation (r=0.74). CONCLUSION: The wound and hyperbaric community would benefit from a simplified procedure for measuring tissue oxygenation. These findings suggest a strong trend toward correlation between NIRS and TCOM. A further study in a larger population is recommended. NIRS offers several advantages over TCOM. Clinicians have immediate point-of-care visualisation of tissue oxygenation using a handheld device. The procedure takes minutes to perform and is less operator-dependent than TCOM. Finally, NIRS allows measurement of oxygenation in the wound bed, while TCOM does not.

Características clínicas y epidemiológicas de las intoxicaciones en el Hospital General Docente Ambato de Ecuador, 2013 a 2014

RESUMEN Objetivos: determinar las características clínicas y epidemiológicas de las intoxicaciones en el Hospital General Docente Ambato de Ecuador desde septiembre del 2013 a agosto del 2014. Materiales y métodos: se realizó un estudio, observacional descriptivo de corte transversal sobre los casos de intoxicación registrados en el Hospital General Docente Ambato. Para la recolección de los datos se creó una planilla electrónica con las variables de interés. Los datos se expresan en proporciones, medidas de tendencia central y dispersión. Resultados: durante el periodo estudiado se registraron 58 casos, en el rango etario de 19 a 30 años se presentó 31,03% de los casos, correspondiendo a organofosforados en 25,86%, alcohol 22,41% y medicamentos 18,96%. Conclusión: se identificó que el porcentaje mayor de las intoxicaciones fueron ocasionadas por organofosforados, los pacientes son atendidos oportunamente y los intentos autolíticos constituyen la principal causa por la que acuden los pacientes intoxicados al Servicio de Emergencia del Hospital Ambato de Ecuador.

ABSTRACT Objectives: To determine the clinical and epidemiological characteristics of poisonings in the Hospital General Docente Ambato of Ecuador from September 2013 to August 2014. Materials and methods: A cross-sectional descriptive, observational study was conducted on intoxication cases registered at the Hospital General Docente Ambato. An electronic spreadsheet with the variables of interest was created for data collection. The data are expressed in proportions, measures of central tendency and dispersion. Results: During the studied period 58 cases were registered, there were 31.03% of the cases in the age range of 19 to 30 years, corresponding to organophosphorus in 25.86%, alcohol 22.41% and medicines 18.96%. Conclusion: It was identified that the highest percentage of poisonings were caused by organophosphates. Patients are treated promptly and autolytic attempts are the main cause of poisoned patients coming to the Emergency Service of the Hospital Ambato of Ecuador.

Case series: Use of Glyceryl Trinitrate patches to improve peripheral circulation in children with severe neurodisability.

AIM: Evaluation of topical Glyceryl trinitrate as a therapeutic option to improve peripheral circulation in 16 children with severe complex neurodisability, poor capillary return and signs of vascular insufficiency, including discomfort. METHODS: If insufficient improvement in capillary return was obtained using conservative measures, a 5 mg GTN patch was placed each day on the front of the tibia of each leg. Children were reviewed clinically for up to 12 months of treatment. Distal limb comfort was measured using a Likert scale, either patient or carer reported. Standardised capillary refill time was assessed at each clinical review. RESULTS: Use of the patches led to improved capillary refill time and parent/patient reported comfort in all children. Healing of skin ulcers in lower limbs after application of the patch was also noted. There was universal parent/patient satisfaction with use of the patch. One child with Aicardi Goutieres syndrome had a skin reaction with prolonged use and minor adverse effects were reported in 4 others but this did not result in discontinuation of treatment. SUMMARY: GTN patches were relatively well tolerated in this group of children. We suggest that use of GTN patches be considered for children with severe neurodisability and poor peripheral circulation causing discomfort. GTN patches may also have a role in healing of persistent skin ulcers for these children.

Peripheral vascular insufficiency impairs functional capacity in patients with heart failure / Insuficiência vascular periférica compromete a capacidade funcional no paciente com insuficiência cardíaca

INTRODUCTION: Heart failure (HF) is a complex syndrome in which effort limitation is associated with deterioration of peripheral musculature. Improving survival rates among these patients have led to the appearance of cases in which other pathologies are associated with HF, such as peripheral vascular insufficiency (PVI). The combination of these two pathologies is common, with significant repercussions for affected patients. OBJECTIVE: To compare functional limitations and quality of life between patients with HF in isolation or HF + PVI. METHOD: Twelve patients with HF+PVI were paired to 12 patients with HF in isolation. All had ejection fraction <40%. The following were conducted: 6 minute walk test (6MWT), chair test (CT), step test (ST), one repetition maximum test (1RM) and quality of life questionnaire. RESULTS: The results for the 6MWT (311±27 vs. 447±29), ST (49±3 vs. 81±10) and CT (17±1 vs. 21±1) were lower in the HF+PVI group than in the HF group (p<0.05). The HF+PVI group exhibited a reduction in the number of steps taken from the first to the second minute of the ST, in relation to the HF group. The HF group exhibited better HR recovery than the HF+PVI group (50±4 vs. 26±3; p<0.05). No differences were found in results for the Borg scale, the peripheral muscle strength test (1RM) or the questionnaires (p>0.05). CONCLUSIONS: The study participants who had mixed disease exhibited a greater degree of functional impairment than the group with HF, without reporting worsened quality of life...

INTRODUÇÃO: A insuficiência Cardíaca (IC) é uma síndrome complexa e a limitação ao esforço está associada à piora da musculatura periférica. Devido à melhora na sobrevida destes pacientes, observa-se o surgimento de patologias associadas à IC, como a insuficiência vascular periférica (IVP). A associação das duas patologias é comum e com grandes prejuízos aos pacientes acometidos. OBJETIVO: Comparar as limitações funcionais e a qualidade de vida em IC isolada e IC + IVP. MÉTODO: Doze pacientes com IC+IVP foram pareados a 12 pacientes com IC isolada. Todos possuíam fração de ejeção <40%. Foram realizados: teste da caminhada de seis minutos (TC6M), teste da cadeira (TCAD), teste do degrau (TD), teste de uma repetição máxima (1RM) e questionário de qualidade de vida. RESULTADOS: Os valores obtidos nos testes TC6M (311±27 vs. 447±29), TD (49±3 vs. 81±10) e TCAD (17±1 vs. 21±1) no grupo IC+IVP foram menores do que no grupo IC (p<0,05), respectivamente. O grupo IC+IVP obteve redução do número de degraus alcançados entre o primeiro e o segundo minuto do TD em relação ao grupo IC. O grupo IC apresentou melhor recuperação da FC em relação ao grupo IC+IVP (50±4 vs. 26±3; p<0,05). Não foi encontrada diferença na escala de Borg, na força muscular periférica (1RM) e nos questionários aplicados (p>0,05). CONCLUSÃO: No presente estudo, os participantes com doença mista apresentaram maior comprometimento funcional em relação ao grupo com IC, sem demonstrar piora na qualidade de vida...