PEGylated curcumin-loaded poly(vinyl alcohol)/Zwitterionic poly(sulfobetaine vinylimidazole)-grafted chitosan nanofiber as a second-degree burn wound dressing.

Burn injuries damage skin function and increased the risk of infection. Using natural-inspired antibiotic-free nanofibrous in wound healing has attracted increasing attention. Here, mPEG-Curcumin (mPEG-CUR) was synthesized through a novel, cheap, and high-efficiency method, and incorporated onto poly(vinyl alcohol) (PVA)/zwitterionic poly(sulfobetaine vinylimidazole)-grafted chitosan (CS-g-PNVIS) nanofiber. Due to the lack of electrospinning capability of CS-g-PNVIS and its brittleness, to obtain nanofibers with uniform and bead-free morphology, PVA was used as an electrospinning aid polymer, so that the prepared nanofibers have suitable mechanical properties with an average diameter between 115 ± 18-157 ± 39 nm. The heat-treated nanofibers have adequate swelling and dimensional stability. Time-killing assay proved the antibacterial activity of the mPEG-CUR-loaded nanofibers towards Gram-positive and Gram-negative bacterium. The MTT investigation illustrated the non-cytotoxicity and biocompatibility of the nanofibers. In vivo studies exhibited significant improvement in the mean wound area closure by applying mPEG-CUR nanofibers. The mPEG-CUR-loaded nanofibers showed the highest antioxidant (86 %) power after 40 min. Moreover, nanofibers possess a desirable WVT rate (3.4 ± 0.24-5.5 ± 0.3 kg/m2.d) and good breathability and had the potential to supply a suitable moist environment in the wounded area. This approach can be the beginning of a new path in designing a new generation of nanofiber mats for wound healing applications.

Evaluating the effect of montelukast tablets on respiratory complications in patients following blunt chest wall trauma: A double-blind, randomized clinical trial.

PURPOSE: Patients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients. METHODS: This randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate. RESULTS: In total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm3) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups. CONCLUSION: Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications.

Maxillofacial Fracture Patterns in Military Casualties.

PURPOSE: Morbidity and death after facial trauma are substantial issues of concern both in civilians and in military personnel. This cross-sectional retrospective study sought to assess the prevalence, pattern, treatment, and complications of soft and hard tissue injuries of the face in military personnel from 2012 to 2018. PATIENTS AND METHODS: This cross-sectional, retrospective, chart study analyzed the descriptive statistics of 591 patients by use of Microsoft Excel software (version 2013; Microsoft, Redmond, WA); we assessed military casualties treated at our hospital from 2012 to 2018. All military personnel were documented in our trauma registry. The patient records were studied, and information relating to patients' injuries was documented and assessed after compilation of patient data. This study was approved by our local institutional review board; the causes and complications of maxillofacial (MF) trauma were assessed. Statistical analysis was done. This study used descriptive statistics based on a total of 591 patients and Microsoft Excel software (version 2013). RESULTS: Among maxillofacial (MF) fractures, midface fractures (49%) were most prevalent, followed by lower face fractures (43%) and upper face fractures (24%). The most common cause of injury was explosives (58%). The most frequent site of fracture in the mandible was the angle region, followed by the mandibular body and condyle. Nasal fractures were seen in 44% of midface fractures. The most commonly used technique for treatment was open reduction-internal fixation, which was used in 89% of patients. CONCLUSIONS: The pattern of MF injuries and the treatment modalities used to treat these patients showed that the most frequent type of injury was midface fracture and most patients were treated by open reduction-internal fixation.

A review of the application of cellulose hemostatic agent on trauma injuries.

INTRODUCTION: Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries. METHODS: We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles. RESULTS: Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients. CONCLUSION: Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.

Comparison of HemoFoam® and Conventional Gauze Dressing on Hemostasis of Vascular Access Site in Hemodialysis Patients.

BACKGROUND: Dialysis access puncture wound bleeding after needle extraction at the end of each hemodialysis session is a very important problem. This study evaluated the effect of HemoFoam® compared to conventional gauze dressing on hemostasis of dialysis access puncture wound bleeding in hemodialysis patients. MATERIALS AND METHODS: This one-group, before-after, clinical-trial was conducted on 60 hemodialysis patients selected by convenience sampling who underwent hemodialysis through arteriovenous fistula in Shahid Rahnemoon Hospital, Yazd, Iran in 2017. After reviewing the eligibility criteria, the study was performed in two separate sessions. In the first session, only HemoFoam® was used while in the second session; the only conventional dressing was used. Time of hemostasis in each puncture wound was evaluated. Data were analyzed by SPSS 22 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp, United States) using paired T-test and Chi-square tests. RESULTS: The mean age of the patients was 55.20±14.25 years. Hemostasis was achieved in 76.6% of cases at the arterial access site in the first two minutes in the HemoFoam® group. The mean homeostasis time in the HemoFoam® group was 2.86±1.87 min at the venous access site and 3.15±1.97 min at the arterial access site (P<0.001). The mean homeostasis time in the conventional dressing group was 10.54±6.65 min at venous access site and 12.74±9.28 min at the arterial access site, which was significantly different between the two groups (P<0.001). CONCLUSION: HemoFoam® is effective in reducing the time of homeostasis in the vascular access site of hemodialysis patients. Therefore, its use in hemodialysis wards is recommended for hemostasis in the dialysis access puncture wound bleeding.

Overview of Agents Used for Emergency Hemostasis.

CONTEXT: In today's modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. EVIDENCE ACQUISITION: A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed. RESULTS: Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding. CONCLUSIONS: The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.

Structural Alteration in Dermal Vessels and Collagen Bundles following Exposure of Skin Wound to Zeolite-Bentonite Compound.

Background. This study examines the impact of one-time direct application of haemostatic agent zeolite-bentonite powder to wounded skin on the healing process in rats. Materials and Methods. 24 male Sprague-Dawley rats were randomly allocated into two groups (n = 12): (1) the rats whose wounds were washed only with sterile normal saline (NS-treated) and (2) those treated with zeolite-bentonite compound (ZEO-treated). The wound was circular, full-thickness, and 2 cm in diameter. At the end of the 12th day, six animals from each group were randomly selected and terminated. The remaining rats were terminated after 21 days. Just after scarification, skin samples were excised and sent for stereological evaluation. Results. The results showed a significant difference between the two groups regarding the length density of the blood vessels and diameter of the large and small vessels on the 12th day after the wound was inflicted. Besides, volume density of both the dermis and collagen bundles was reduced by 25% in the ZEO-treated rats in comparison to the NS-treated animals after 21 days. Conclusions. One-time topical usage of zeolite-bentonite haemostatic powder on an animal skin wound might negatively affect the healing process through vasoconstriction and inhibition of neoangiogenesis.

The effect of CoolClot hemostatic agent on skin wound healing in rats.

BACKGROUND: Hemostatic agents can play a key role in controlling severe hemorrhage after trauma. Previously, some criteria have been defined for improving the quality of these products; one of them is that the hemostat causes no further tissue injury. CoolClot is a recently introduced hemostatic agent that its effects on wound healing have not yet been examined, which this study aims to address. MATERIALS AND METHODS: Thirty-four adult male Sprague-Dawley rats were assigned randomly to two groups (n = 17): a study group where CoolClot hemostatic agent was applied on their wounds, and a control group whose wounds were washed only with sterile saline. The rats underwent dorsal full-thickness skin excisional wounds (20 mm diameter). On day 12 after wounding, seven rats were chosen in a random manner from each of the groups of study and control, and their skin biopsies from the wound sites were sent for histologic examination. Skin samples of the remaining rats in each group were taken on the 21st d after wound creation. Wound healing was also monitored photographically. In addition, wound surface temperature after wounding, and the application of CoolClot was recorded. RESULTS: There was no significant difference between the groups of study and control regarding the examined histopathologic parameters. The maximum increase in wound surface temperature was 1.56°C. CONCLUSIONS: One-time topical usage of CoolClot has no significant negative effect on the wound healing process. In addition, no significant increase in wound surface temperature will occur after the application of this agent.

Validation of an Iranian Trauma Data Collection Form.

BACKGROUND: Knowing the direction of traumatic injury is important as the information can help avoid death after trauma. A trauma registry usually entails detailed information about the demographics, cause, intensity of the injury, and the final diagnosis and outcome of the trauma-affected patient. Researchers should be able to evaluate all aspects of trauma injury and the patient's status. OBJECTIVES: The purpose of this study was to develop a trauma data collection form. MATERIALS AND METHODS: The development of the trauma registry form began in February 2013. The variables were finalized by a team consisting of general and trauma surgeons, specialists in emergency medicine, orthopedists, neurosurgeons, and public health professionals who have special interest in trauma research. The scale was sent to 10 specialists for validation. RESULTS: After assessing the scale validity twice, it was accepted with an integrator agreement of 0.89. The test-retest reliability was assessed in a convenience sample of 20 physicians (Kendall t = 0.97; P < 0.001). Such a high reliability may reflect redundancy of some items. CONCLUSIONS: It is essential to establish a secure multicenter trauma registry in Iran for data collection, storage, and assessment of traumatic injury and these registries must be easy to install and use.

Evaluation of chitosan-gelatin films for use as postoperative adhesion barrier in rat cecum model.

BACKGROUND: Postoperative adhesions remain a significant complication of abdominal surgery and can result in pain, infertility and potentially lethal bowel obstruction. Pharmacotherapy and barrier devices have reduced adhesion formation to varying degrees in preclinical studies or clinical trials. MATERIALS AND METHODS: In this study, we produced blends between chitosan (Ch) and gelatin (G) with various compositions (Ch/G 100/0, 75/25, 50/50, 25/75 w/w) as candidate materials for prevention of postoperative abdominal adhesion. For in vivo analysis, 30 female rats weighing 200-250 g were divided into 5 groups (One control and 4 treatment groups). Under general anesthesia, the anterior surface of serous membrane in rat was scraped slightly with sterile gauze until obvious congestion and small bleeding drops appeared, then sample films set on the cecum in treatment groups and the intestine was put back into the abdominal cavity, which were then closed. After 4 weeks, the abdominal cavity was reopened and the grades of peritoneal adhesion were studied by macroscopic and pathologic assessments. RESULTS: Our results showed Ch1/G3 films had an insignificant reduction effect on postoperative adhesion, but surprisingly, the sample with more than 25% by weight of chitosan did not have any effect on reducing adhesion formation but also increased inflammation near the cecum. CONCLUSION: Administration of chitosan-gelatin films with higher than 25% weight of chitosan had no effect on reduction of adhesion formation in the rat cecum model.

Macroscopic and pathological assessment of methylene blue and normal saline on postoperative adhesion formation in a rat cecum model.

BACKGROUND: Adhesion formation after abdominal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic abdominal pain. In this study, we evaluated the effect of normal saline and methylene blue (MB) on postoperative adhesion formation in a rat cecum model. METHODS: A total of 30 Wistar female rats in 2 treatment and 1 control groups underwent midline laparotomy and standardized abrasion of the visceral peritoneum. Normal saline and methylene blue were administrated intraperitoneally at the end of the surgical procedure in 2 treatment groups. Fourteen days after surgery, a re-laparotomy was performed for macroscopic and pathological assessment. RESULTS: The adhesion grade and extent of the normal saline group was lower than control and MB groups in macroscopic assessment (P<0.05 for both). A comparison of adhesion stages in pathological assessment showed increment in abdominal adhesion by usage methylene blue 1% and demonstrated significant difference between MB and 2 other groups (P<0.05). CONCLUSIONS: Administrated normal saline individually reduce the adhesion grade near cecum. Conversely, usage of methylene blue 1% may unpredictably increase risk of adhesion formation.

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy.

BACKGROUND: Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time. OBJECTIVES: The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method. MATERIALS AND METHODS: IN THIS RANDOMISED CONTROLLED CLINICAL TRIAL, MALE PATIENTS WITH UNILATERAL INGUINAL HERNIA WERE RANDOMIZED INTO TWO GROUPS: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis. RESULTS: All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery). CONCLUSIONS: Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.