Rapid Colorimetric Detection of Wound Infection with a Fluidic Paper Device.

Current procedures for the assessment of chronic wound infection are time-consuming and require complex instruments and trained personnel. The incidence of chronic wounds worldwide, and the associated economic burden, urge for simple and cheap point-of-care testing (PoCT) devices for fast on-site diagnosis to enable appropriate early treatment. The enzyme myeloperoxidase (MPO), whose activity in infected wounds is about ten times higher than in non-infected wounds, appears to be a suitable biomarker for wound infection diagnosis. Herein, we develop a single-component foldable paper-based device for the detection of MPO in wound fluids. The analyte detection is achieved in two steps: (i) selective immunocapture of MPO, and (ii) reaction of a specific dye with the captured MPO, yielding a purple color with increasing intensity as a function of the MPO activity in infected wounds in the range of 20-85 U/mL. Ex vivo experiments with wound fluids validated the analytic efficiency of the paper-based device, and the results strongly correlate with a spectrophotometric assay.

Nanoparticle-driven self-assembling injectable hydrogels provide a multi-factorial approach for chronic wound treatment.

Chronic wounds represent a major health burden and drain on medical system. Efficient wound repair is only possible if the dressing materials target simultaneously multiple factors involved in wound chronicity, such as deleterious proteolytic and oxidative enzymes and high bacterial load. Here we develop multifunctional hydrogels for chronic wound management through self-assembling of thiolated hyaluronic acid (HA-SH) and bioactive silver-lignin nanoparticles (Ag@Lig NPs). Dynamic and reversible interactions between the polymer and Ag@Lig NPs yield hybrid nanocomposite hydrogels with shear-thinning and self-healing properties, coupled to zero-order kinetics release of antimicrobial silver in response to infection-related hyalurodinase. The hydrogels inhibit the major enzymes myeloperoxidase and matrix metalloproteinases responsible for wound chronicity in a patient's wound exudate. Furthermore, the lignin-capped AgNPs provide the hydrogel with antioxidant properties and strong antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa. The nanocomposite hydrogels are not toxic to human keratinocytes after 7 days of direct contact. Complete tissue remodeling and restoration of skin integrity is demonstrated in vivo in a diabetic mouse model. Hematological analysis reveals lack of wound inflammation due to bacterial infection or toxicity, confirming the potential of HA-SH/Ag@Lig NPs hydrogels for chronic wound management. STATEMENT OF SIGNIFICANCE: Multifunctional hydrogels are promising materials to promote healing of complex wounds. Herein, we report simple and versatile route to prepare biocompatible and multifunctional self-assembled hydrogels for efficient chronic wound treatment utilizing polymer-nanoparticle interactions. Hybrid silver-lignin nanoparticles (Ag@Lig NPs) played both: i) structural role, acting as crosslinking nodes in the hydrogel and endowing it with shear-thinning (ability to flow under applied shear stress) and self-healing properties, and ii) functional role, imparting strong antibacterial and antioxidant activity. Remarkably, the in situ self-assembling of thiolated hyaluronic acid and Ag@Lig NPs yields nanocomposite hydrogels able to simultaneously inhibits the major factors involved in wound chronicity, namely the overexpressed deleterious proteolytic and oxidative enzymes, and high bacterial load.

New myeloperoxidase detection system based on enzyme-catalysed oxidative synthesis of a dye for paper-based diagnostic devices.

The severity and cost of wound infections strongly demands for simple and fast methods for wound infection determination. Point-of-care testing devices play a crucial role in order to achieve a fast diagnosis and early treatment. Myeloperoxidase (MPO) enzyme, detected in fluids of infected wounds has been postulated as a suitable biomarker for wound diagnostics. Here we present a new system for MPO detection, based on enzyme-catalysed oxidative synthesis of a dye that can be incorporated into paper-based point of care devices. Visual MPO detection has been achieved through the use of phenylenediamine, a common colourless hair dye precursor. MPO oxidation of these compounds yielded bright coloured products distinguishable from the colour of the wound environment. Immobilisation of the MPO substrates on paper strips was achieved through in situ interaction of the oxidised coloured product with branched polyethyleneimine. The colour reaction of the immobilized substrates, detectable by naked eye, responds to the MPO levels present in infected wound fluids revealing an easy system for incorporation of MPO detection in paper based diagnostic devices.

Enzymatic synthesis of a thiolated chitosan-based wound dressing crosslinked with chicoric acid.

This work describes the enzymatic synthesis of multifunctional hydrogels for chronic wound treatment using thiolated chitosan and the natural polyphenol chicoric acid. Gelation was achieved by laccase-catalyzed oxidation of chicoric acid, a natural compound used for the first time as a homobifunctional crosslinker, reacting subsequently with nucleophilic thiol and amino groups from the chitosan derivative. This approach allowed for twice as fast gelation at a three-fold reduced crosslinking reagent concentration, compared to reported enzymatic synthesis of hydrogels using gallic acid as a phenolic provider. Hydrogels with 600% swelling capacity, coupled with only 20% weight loss after 6 days under physiological conditions, were obtained. The clinically relevant Gram-positive Staphylococcus aureus and the Gram-negative Pseudomonas aeruginosa were reduced by up to 4.5 and 5.5 logs, respectively. A tunable, in the range of 20-95%, ex vivo inhibition of myeloperoxidase (MPO) activity in chronic wound exudate was achieved, together with control over the total matrix metalloproteinase (MMP) activities.

Multifunctional Enzymatically Generated Hydrogels for Chronic Wound Application.

The healing of chronic wounds requires intensive medical intervention at huge healthcare costs. Dressing materials should consider the multifactorial nature of these wounds comprising deleterious proteolytic and oxidative enzymes and high bacterial load. In this work, multifunctional hydrogels for chronic wound application were produced by enzymatic cross-linking of thiolated chitosan and gallic acid. The hydrogels combine several beneficial to wound healing properties, controlling the matrix metalloproteinases (MMPs) and myeloperoxidase (MPO) activities, oxidative stress, and bacterial contamination. In vitro studies revealed above 90% antioxidant activity, and MPO and collagenase inhibition by up to 98 and 23%, respectively. Ex vivo studies with venous leg ulcer exudates confirmed the inhibitory capacity of the dressings against MPO and MMPs. Additionally, the hydrogels reduced the population of the most frequently encountered in nonhealing wounds bacterial strains. The stable at physiological conditions and resistant to lysozyme degradation hydrogels showed high biocompatibility with human skin fibroblasts.

[CLINICAL CASES-TREATED WITH TECHNOLOGY LIPID COLLOIDAL (TLC)]. / Casos clinicos tratados con La tecnologia lipido coloidal (TLC).

INTRODUCTION: This study presents clinical cases collecting etiologies that are more frequent in the field of complex wounds. All require a specific approach, as well as the interdisciplinary participation of different members of the team. But in general, established local cure plans may be quite similar. Applies them technology lipid colloidal (TLC) which consists of the combination of particles of hydrocolloid (carboxymethylcellulose) with lipid components. Products with a technology designed for every moment of healing. OBJECTIVE: Show our experience in the use of products with TLC in patients with ulcers of different etiologies. METHOD: The following products depending on the case have been used to treat: UrgoTul Absorb Border, Urgoclean (rope or plate), UrgoStart, UrgoK2 and UrgoK2 LITE. These products were applied in patients presenting four different etiologies of ulcer: hypertensive, traumatic, venous and ischemic ulcer. The use of Urgoclean rope favored cleaning the bed ulceral and applied Urgoclean plate with reinforced alginate to control the abundant exudates, with coverage of UrgoTul ABsorb Border. Once clean beds pass UrgoStart and at all times UrgoK2 bandage, cases that required compressive therapy. Intolerance to that kind of compression applied to patients presenting bandage UrgoK2 LITE (which tolerated without problem) which significantly reduced edema, favoring the control of exudate. Patients with ulcer of long evolution, at the start were reluctant to the application of new technologies, but after the first cures and sensing a good evolution, we get their confidence and commitment to the resolution. RESULTS: Are displayed clinical cases of different etiologic and personal contexts that an integral and interdisciplinary approach together with the application of products with TLC, managed to solve the problem. CONCLUSION: The materials used have been satisfactory in all cases, with a direct involvement in the resolution of lesions which carries a long unresolved, and in any of them, even with a diagnosis of poor prognosis. In the clinical practice of the wound care knowledge and research of new materials that improve the quality of life of patients, reducing the time evolution of the lesions is very important. Not to mention that education for the prevention of their health should be one of the objectives to prevent recurrences.

Casos clínicos tratados con la tecnología lípido coloidal (TLC) / Clinical cases treated with tecjnology lipid colloidal (TLC)

Introducción. En este estudio se exponen casos clínicos que recogen las etiologías más frecuentes en el campo de las heridas complejas. Todas requieren un abordaje específico, además de la participación interdisciplinar de diferentes miembros del equipo. Sin embargo, en general, los planes de cura locales establecidos pueden ser bastante similares. Se les aplica la tecnología lípido coloidal (TLC) que consiste en la combinación de partículas de hidrocoloide (carboximetilcelulosa) con componentes lipídicos. Son productos con una tecnología diseñada para cada momento de la cicatrización. Objetivo. Dar a conocer nuestra experiencia en la utilización de productos con TLC en pacientes con úlceras de diferentes etiologías. Método. Se han utilizado los siguientes productos dependiendo del caso que tratar: UrgoTul® Absorb Border, Urgoclean® (mecha o placa), UrgoStart®, UrgoK2® y UrgoK2 LITE®. Estos productos se aplicaron en pacientes que presentaban cuatro etiologías de úlcera diferentes: úlcera hipertensiva, traumática, venosa e isquémica (arterial). La utilización de Urgoclean® mecha favoreció la limpieza del lecho ulceral y se aplicó Urgoclean® placa con alginato reforzado para controlar los exudados abundantes, con cobertura de UrgoTul® Absorb Border. Una vez limpios los lechos, pasamos a UrgoStart® y usamos en todo momento vendaje UrgoK2®, en los casos que precisaban terapia compresiva. A los pacientes que presentaban intolerancia a ese tipo de compresión se les aplicó el vendaje UrgoK2 LITE® (que toleraron sin problema), lo que redujo notablemente el edema y favoreció el control del exudado. Los pacientes con heridas de larga evolución se mostraron al inicio reticentes a la aplicación de nuevas tecnologías, pero, trascurridas las primeras curas, y al percibir una buena evolución, confiaron y se adhirieron al tratamiento hasta la resolución. Resultados. Se muestran casos clínicos de diferentes contextos etiológicos y personales, de los que, con un abordaje integral e interdisciplinar, junto con la aplicación de productos con TLC, se consiguió resolver la problemática. Conclusión. Los materiales utilizados han sido satisfactorios en todos los casos, con una implicación directa en la resolución de las lesiones que conllevaban un largo tiempo sin resolver y, en alguno de ellos, incluso con un diagnóstico de mal pronóstico. En la práctica clínica del cuidado de las heridas es muy importante el conocimiento y la investigación de nuevos materiales que mejoren la calidad de vida de los pacientes y reduzcan el tiempo de evolución de las lesiones. Sin olvidar que la educación para la prevención de su salud debe ser uno de los objetivos para evitar las recidivas (AU)

Introduction. This study presents clinical cases collecting etiologies that are more frequent in the field of complex wounds. All require a specific approach, as well as the interdisciplinary participation of different members of the team. But in general, established local cure plans may be quite similar. Applies them technology lipid colloidal (TLC) which consists of the combination of particles of hydrocolloid (carboxymethylcellulose) with lipid components. Products with a technology designed for every moment of healing. Objective. Show our experience in the use of products with TLC in patients with ulcers of different etiologies. Method. The following products depending on the case have been used to treat: UrgoTul® Absorb Border, Urgoclean® (rope or plate), UrgoStart®, UrgoK2® and UrgoK2 LITE®. These products were applied in patients presenting four different etiologies of ulcer: hypertensive, traumatic, venous and ischemic ulcer. The use of Urgoclean® rope favored cleaning the bed ulceral and applied Urgoclean® plate with reinforced alginate to control the abundant exudates, with coverage of UrgoTul ABsorb Border®. Once clean beds pass UrgoStart® and at all times UrgoK2® bandage, cases that required compressive therapy. Intolerance to that kind of compression applied to patients presenting bandage UrgoK2 LITE® (which tolerated without problem) which significantly reduced edema, favoring the control of exudate. Patients with ulcer of long evolution, at the start were reluctant to the application of new technologies, but after the first cures and sensing a good evolution, we get their confidence and commitment to the resolution. Results. Are displayed clinical cases of different etiologic and personal contexts that an integral and interdisciplinary approach together with the application of products with TLC, managed to solve the problem. Conclusion. The materials used have been satisfactory in all cases, with a direct involvement in the resolution of lesions which carries a long unresolved, and in any of them, even with a diagnosis of poor prognosis. In the clinical practice of the wound care knowledge and research of new materials that improve the quality of life of patients, reducing the time evolution of the lesions is very important. Not to mention that education for the prevention of their health should be one of the objectives to prevent recurrences (AU)

Conocimiento de los profesionales de urgencias sobre la prevención y tratamiento de las úlceras por presión / Professional’s knowledge of the department of urgencies on the prevention and treatment of pressure ulcers

Introducción: muy frecuentemente en el medio de las urgencias hospitalarias suele infravalorarse la frecuencia, la repercusión personal, social e incluso económica, tanto delas úlceras por presión (UPP) como de otras heridas crónicas. Las situaciones críticas precisan de una urgente atención y obligan a establecer prioridades como la estabilidad del paciente agudo, anteponiéndose a otras situaciones de menor relevancia. Pero la necesidad de abordar una "urgencia" no puede desmerecer o anular el abordaje de otras situaciones no críticas, que pueden influir notablemente en el paciente y en su estado de salud. Partiendo de estos criterios, podríamos formularnos algunas preguntas:• ¿Está el personal de urgencias "formado" para abordar correctamente las UPP y otras heridas crónicas?• ¿Se aplican las estrategias adecuadas de prevención y tratamiento dentro de los servicios de urgencias? Objetivo: analizar los conocimientos de los profesionales de urgencias, con responsabilidad en el cuidado de los pacientes: equipo de enfermería (diplomado y auxiliar), equipo médico (adjunto y residente) y equipo sanitario; sobre la prevención y el (..) (AU)

Introduction: very frequently in the way of the hospitable urgencies there is in the habit of being underestimated the frequency, the personal, social and even economic repercussion, so much of the pressure ulcers, as of other chronic wounds. The critical situations are necessary an urgent attention and force to establish priorities as the stability of the critical patient, being in front of other situations of minor relevancy. But the need to approach a hospitable urgency, cannot be unworthy or annul the boarding of other not critical situations, which can influence notably in the patient and his condition of health. Departing from these criteria, it might formulate some questions:• Are the personnel of urgencies "formed" to correctly approach pressure ulcers and other (..) (AU)