RESUMO
Distal limb wounds are common injuries sustained by horses and their healing is fraught with complications due to equine anatomy, prevalence of infection, and challenges associated with wound management. Gallium is a semi-metallic element that has been shown to possess antimicrobial properties and aid in wound healing in various preclinical models. The effects of Gallium have not been studied in equine wound healing. Therefore, the objective of this study was to compare healing rates between gallium-treated and untreated wounds of equine distal limbs and to demonstrate the antimicrobial effects of gallium on wounds inoculated with S. aureus. Using an established model of equine wound healing we demonstrated beneficial effects of 0.5% topical gallium maltolate on equine wound healing. Specifically we documented reduced healing times, reduced bioburden, and reduced formation of exuberant granulation tissue in wounds treated with gallium maltolate as compared with untreated wounds. Gallium appeared to exert its beneficial effects via its well-described antimicrobial actions as well as by altering the expression of specific genes known to be involved in wound healing of horses and other animals. Specifically, gallium maltolate appeared to increase expression of transforming growth factor-ß in both infected and un-infected wounds. Further work is needed to document the effects of gallium on naturally occurring equine wounds and to compare the effects of gallium with other wound treatment options. These data, however, suggest that gallium may be an attractive and novel means of improving equine distal limb wound healing.
Assuntos
Antibacterianos/uso terapêutico , Doenças dos Cavalos/tratamento farmacológico , Traumatismos da Perna/tratamento farmacológico , Compostos Organometálicos/uso terapêutico , Pironas/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Administração Tópica , Animais , Antibacterianos/administração & dosagem , Carga Bacteriana , Citocinas/genética , Citocinas/metabolismo , Doenças dos Cavalos/metabolismo , Cavalos , Traumatismos da Perna/metabolismo , Traumatismos da Perna/veterinária , Compostos Organometálicos/administração & dosagem , Pironas/administração & dosagem , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/veterinária , CicatrizaçãoRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Exantema/induzido quimicamente , Etoricoxib/efeitos adversos , Exantema/tratamento farmacológico , Clobetasol/uso terapêutico , Hipersensibilidade a Drogas/tratamento farmacológico , Etoricoxib/administração & dosagem , Traumatismos da Perna/tratamento farmacológico , Edema Macular/complicações , Administração TópicaRESUMO
Nexobrid is a new resource for debridement that has emerged in recent years and is gaining relevance in the treatment of all kinds of thermal injuries. This product is an ointment (formed with a mixture of pineapple-derived enzymes enriched with bromelain) that is directly applied over the burn. With a single application, it performs a burned tissue-specific debridement in less than 4 hr, leaving a vital and completely debrided wound bed. In this article, we describe our experience with this product, and through a representative case, we explain the management of these patients in our Burns unit in consonance with national and international consensus.
Assuntos
Bromelaínas/administração & dosagem , Queimaduras/tratamento farmacológico , Desbridamento/métodos , Adulto , Bromelaínas/farmacologia , Queimaduras/classificação , Queimaduras/enzimologia , Traumatismos do Pé/tratamento farmacológico , Humanos , Traumatismos da Perna/tratamento farmacológico , MasculinoRESUMO
Pain control is an important concern in limb trauma. The most ideal agent for this purpose varies among different hospitals. The objective of this study was to compare the analgesic effect of oral diclofenac potassium versus intravenous acetaminophen in patients with limb trauma. This was a double-blind randomized clinical trial conducted on 60 adult patients. Oral diclofenac potassium (50 mg) was given in Group D, and intravenous acetaminophen (1 g in 500 ml normal saline over 20 min) was administered in Group A. Patients' pain scores (visual analogue scale) were recorded and compared at baseline, 5, 15, 30, 60 min, and 4 hr after drug administration. The mean age was 42.62 ± 15.42 and 38.04 ± 17.48 years in Group A and Group D, respectively. No significant change was observed between the 2 groups (p = 0.11). In this study, both drugs could decrease the pain score effectively and safely in isolated limb trauma.
Assuntos
Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Traumatismos do Braço/tratamento farmacológico , Diclofenaco/administração & dosagem , Serviço Hospitalar de Emergência , Traumatismos da Perna/tratamento farmacológico , Manejo da Dor/métodos , Ferimentos não Penetrantes/tratamento farmacológico , Administração Intravenosa , Administração Oral , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Medição da Dor , Resultado do TratamentoAssuntos
Analgésicos Opioides/administração & dosagem , Prescrições de Medicamentos , Traumatismos do Antebraço/tratamento farmacológico , Fraturas Ósseas/tratamento farmacológico , Traumatismos da Perna/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Feminino , Fíbula/lesões , Traumatismos do Antebraço/epidemiologia , Fraturas Ósseas/epidemiologia , Humanos , Traumatismos da Perna/epidemiologia , Masculino , Medicare/tendências , Pessoa de Meia-Idade , Rádio (Anatomia)/lesões , Tíbia/lesões , Ulna/lesões , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The immobilisation of the lower leg is associated with deep vein thrombosis (DVT). However, thromboprophylaxis in patients with a below-knee plaster cast remains controversial. We examined the efficacy and safety of nadroparin and fondaparinux to ascertain the need for thromboprophylaxis in these patients. METHODS: PROTECT was a randomised, controlled, single-blind, multicentre study that enrolled adults with an ankle or foot fracture who required immobilisation for a minimum of four weeks. The patients were randomly assigned (1:1:1) to a control group (no thromboprophylaxis) or to one of the intervention groups: daily subcutaneous self-injection of either nadroparin (2850 IE anti-Xa=0.3ml) or fondaparinux (2.5mg=0.5ml). A venous duplex sonography was performed after the removal of the cast or earlier if thrombosis was suspected. The primary outcome was the relative risk of developing DVT in the control group compared with that in both intervention groups. This trial is registered at ClinicalTrials.gov, number NCT00881088. RESULTS: Between April 2009 and December 2015, 467 patients were enrolled and assigned to either the nadroparin group (n=154), the fondaparinux group (n=157), or the control group (n=156). A total of 273 patients (92, 92, and 94 patients, respectively) were analysed. The incidence of DVT in the nadroparin group was 2/92 (2.2%) compared with 11/94 (11.7%) in the control group, with a relative risk of 5.4 (95% CI 1.2-23.6; p=0.011). The incidence of DVT in the fondaparinux group was 1/92 (1.1%), yielding a relative risk of 10.8 (95% CI 1.4-80.7; p=0.003) compared with that in the control group. No major complications occurred in any group. CONCLUSION: Thromboprophylaxis with nadroparin or fondaparinux significantly reduces the risk of DVT in patients with an ankle or foot fracture who were treated in a below-knee cast without any major adverse events.
Assuntos
Anticoagulantes/uso terapêutico , Imobilização , Traumatismos da Perna/fisiopatologia , Traumatismos da Perna/terapia , Nadroparina/uso terapêutico , Polissacarídeos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Trombose Venosa/prevenção & controle , Adulto , Moldes Cirúrgicos/efeitos adversos , Feminino , Fondaparinux , Humanos , Imobilização/efeitos adversos , Traumatismos da Perna/complicações , Traumatismos da Perna/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoRESUMO
Injuries to the skin are extensively costly to the health care system. When caused by metabolic and vascular compromise, these injuries are even more foreboding for patients. They can result in chronic inflammation, reduced mobility, and chronic pain. MATERIALS AND METHODS: Twenty patients were selected from the author's patient population at the West Boca Center for Wound Healing for a retrospective cohort study. Patients underwent a run-in period of 2 weeks, where standard of care was used to clear the wound of bioburden. A dehydrated, human amniotic membrane (dHAM; WoundEx Membrane, Skye Biologics, Inc, El Segundo, CA) was applied at weeks 1 (2 weeks post run-in), 3, and 5, if necessary. Wound measurements and photographs were performed weekly. Data were collected through a standard form in each patient's medical record to improve reliability and reproducibility. The data extraction was performed by the author and to reduce bias. Reduction of bias was performed by selecting patients whose wounds already were established and in temporal sequence. RESULTS: In this review of 20 patients treated with the dHAM, the author was able to effectively close all wounds in approximately 9.9 weeks (69.3 days). A linear relationship was discovered between wound size in cm2 and days to closure. Diabetic foot ulcers closed on average in 11.8 weeks (82.6 days) and venous leg ulcers in 9.2 weeks (64.4 days). No adverse events were noted secondary to the dHAM application, which shows this is a safe and effective treatment option. As of the date of this publication, there is no recurrence of the ulcerations noted. CONCLUSION: The use of this particular dHAM allograft effectively closed diabetic foot ulcerations in 82.6 days and median wound closure in 69.3 days. This poses as an advantageous clinical benefit in the scope of treatment of lower extremity wounds.
Assuntos
Âmnio/transplante , Traumatismos da Perna/tratamento farmacológico , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Dessecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cicatrização/efeitos dos fármacosAssuntos
Aspirina/uso terapêutico , Fenilpropionatos/uso terapêutico , Prurigo/tratamento farmacológico , Prurido/tratamento farmacológico , Administração Cutânea , Administração Oral , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides , Aspirina/administração & dosagem , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Quimioterapia Combinada , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Cefaleia/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/administração & dosagem , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Achados Incidentais , Traumatismos da Perna/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Fenilpropionatos/administração & dosagem , Prurigo/sangue , Prurido/sangue , Roxitromicina/administração & dosagem , Roxitromicina/uso terapêutico , Falha de Tratamento , Escala Visual AnalógicaRESUMO
Results of treatment of 242 patients, to whom 697 оperative interventions were done, including 492 (70.6%) with restoration of the injured soft tissues and other trunk and extremities structures were analyzed. Choice of the correcting intervention method and closure of the covering tissues defect have depended on the wound dimensions and depth, peculiarities of hemodynamics in the area injured. Application of Lacert preparation for the traumatic injury consequences made spectrum of treatment options in patients, suffering covering tissues defect,broader. Differential approach to choice of procedure for the wound surface closure have permitted to achieve satisfactory results in 98.75% of patients.
Assuntos
Traumatismos do Braço/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Traumatismos da Perna/cirurgia , Lesões dos Tecidos Moles/cirurgia , Traumatismos Torácicos/cirurgia , Adulto , Traumatismos do Braço/tratamento farmacológico , Traumatismos do Braço/patologia , Feminino , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Hemodinâmica , Humanos , Ácido Hialurônico/uso terapêutico , Traumatismos da Perna/tratamento farmacológico , Traumatismos da Perna/patologia , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/patologia , Traumatismo Múltiplo/cirurgia , Medicina de Precisão , Estudos Retrospectivos , Pele/efeitos dos fármacos , Pele/lesões , Transplante de Pele , Lesões dos Tecidos Moles/tratamento farmacológico , Lesões dos Tecidos Moles/patologia , Retalhos Cirúrgicos , Traumatismos Torácicos/tratamento farmacológico , Traumatismos Torácicos/patologia , Índices de Gravidade do TraumaRESUMO
OBJECTIVE: Intravenous morphine has been used as a common method of pain control in emergency care. Nebulized fentanyl is also an effective temporary substitute. This study was designed to compare the effectiveness of nebulized fentanyl with intravenous (IV) morphine on management of acute limb pain. METHODS: This was a placebo-controlled, double-blind randomized clinical trial. Ninety emergency department patients with moderate to severe pain aged 15 to 50 years were blocked randomized and enrolled in this study. Forty-seven patients in the experimental group received nebulized fentanyl (4 µg/kg) and IV normal saline as placebo, and the remaining 43 patients in the control group received IV morphine (0.1 mg/kg) and nebulized normal saline as placebo. All participants' pain scores were assessed by Numerical Rating Scale before and after intervention at 5-, 10-, 15-, 30-, 45-, and 60-minute intervals. Patients' vital sign and possible adverse effects were recorded respectively. Finally, all participants were assessed for their satisfaction. RESULTS: The mean initial pain score in the experimental group was 8.7 and 8.4 in the control group (P = .1). Pain relief in both groups after 5 and 10 minutes were similar (P = .72). Although the pain relief was significantly greater with fentanyl at 15 minutes, this difference is not clinically significant. Pain management in both groups was successful and was more than 3 scores reduction in Numerical Rating Scale. Patient satisfaction in both groups was similar. No adverse effects were reported in the experimental group. CONCLUSION: This study suggests that nebulized fentanyl is a rapid, safe, and effective method for temporary control of acute limb pain in emergency department patients.
Assuntos
Dor Aguda/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Traumatismos do Braço/tratamento farmacológico , Serviço Hospitalar de Emergência , Fentanila/uso terapêutico , Traumatismos da Perna/tratamento farmacológico , Morfina/uso terapêutico , Administração por Inalação , Adulto , Analgésicos Opioides/administração & dosagem , Método Duplo-Cego , Feminino , Fentanila/administração & dosagem , Humanos , Injeções Intravenosas , Masculino , Morfina/administração & dosagem , Medição da Dor , Satisfação do Paciente , Fatores de TempoRESUMO
Acute muscle belly injuries to the semitendinosus, semimembranosus and biceps femoris (the 'hamstring' muscles) remain a common problem in the sporting population. Physiotherapy-led rehabilitation remains the mainstay of treatment, and the physician's input is often minimal. Anecdotally, many different topical, oral and injectable therapies are used around the world in an effort to accelerate the healing of these injuries and to prevent their recurrence. This article reviews the evidence available to support some of the most commonly used medical therapies and the pathophysiological basis for their use. It also presents the evidence behind some of the more promising future treatments for muscle injury, including stem cell therapy, growth factor delivery and potential novel uses of current medication not traditionally used in the musculoskeletal setting.
Assuntos
Traumatismos em Atletas/terapia , Traumatismos da Perna/terapia , Músculo Esquelético/fisiopatologia , Traumatismos em Atletas/tratamento farmacológico , Traumatismos em Atletas/reabilitação , Humanos , Traumatismos da Perna/tratamento farmacológico , Traumatismos da Perna/reabilitaçãoRESUMO
BACKGROUND: The effectiveness of intranasal (IN) fentanyl as an analgesic for painful pediatric limb injuries in the Emergency Department (ED) has been reported previously. However, efficacy of IN ketamine in sub-dissociative doses is not well studied in the ED setting. A non-blinded pilot study undertaken by this study group suggested that IN ketamine showed similar analgesic effectiveness to that reported with IN fentanyl in similar non-blinded studies. The aim of this randomized, controlled, equivalence trial is to compare the analgesic effect of sub-dissociative dose IN ketamine with IN fentanyl for children with isolated musculoskeletal limb injuries. METHODS/DESIGN: This is a prospective, randomized, controlled, double-blind equivalence trial of children agedthree to thirteen years and less than 50 kg body weight, with isolated musculoskeletal limb injury, presenting to the ED with moderate to severe pain, defined as a verbal response of at least six to a standard 11-point scale (0=none, 10=worst pain imaginable). Pain score, sedation, satisfaction with analgesic intervention, and adverse effects will be assessed over a 60 minute interval for each participant. Intranasal ketamine (1 mg/kg) or fentanyl (1.5 microgram/kg) will be administered via blinded syringe and mucosal atomization device in a standardized volume at 0.03 ml/kg, with a maximum volume of 1.5 ml divided equally to both nares. Participants will also receive 10 mg/kg ibuprofen orally. The primary outcome measure will be median change in pain score from pre-administration to 30 minutes post-administration. Non-parametric Mann-Whitney U tests will be computed to compare median change in the primary outcome measure for IN ketamine and fentanyl. A sample size of 36 participants per group is needed to detect the expected 40 mm reduction in pain rating with a 95% confidence interval (CI) no greater than ±10 mm at 30 minutes. Rescue analgesia will be given as IN fentanyl or intravenous morphine. DISCUSSION: This is the first randomized-controlled trial comparing the efficacy of these two analgesic agents via the intranasal route. If IN ketamine is found to be equally effective to IN fentanyl for this indication, it will provide another analgesic agent that may be considered for the relief of acute pain in children in the ED. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000795897.
Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos/administração & dosagem , Traumatismos do Braço/tratamento farmacológico , Fentanila/administração & dosagem , Ketamina/administração & dosagem , Traumatismos da Perna/tratamento farmacológico , Dor Musculoesquelética/tratamento farmacológico , Projetos de Pesquisa , Administração Intranasal , Adolescente , Fatores Etários , Analgésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Traumatismos do Braço/diagnóstico , Criança , Pré-Escolar , Protocolos Clínicos , Método Duplo-Cego , Fentanila/efeitos adversos , Humanos , Ketamina/efeitos adversos , Traumatismos da Perna/diagnóstico , Dor Musculoesquelética/diagnóstico , Medição da Dor , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , VitóriaRESUMO
Overuse injuries are a common and important cause of morbidity in elite and recreational athletes. They are increasingly recognized in the sedentary population. This article reviews the major classes of overuse injuries of the lower extremity. The underlying pathologic condition is correlated with the imaging appearances, and the often variable relationship between the imaging appearances and patients' symptoms are reviewed. Attempts at imaged-based grading systems and the ability of imaging to predict patients' prognosis are considered. Image-guided injection therapy for tendinopathy is an important and rapidly changing area; the indications, risks, and potential benefits of these interventions are reviewed.
Assuntos
Traumatismos em Atletas/diagnóstico , Transtornos Traumáticos Cumulativos/diagnóstico , Diagnóstico por Imagem , Traumatismos da Perna/diagnóstico , Traumatismos dos Tendões/diagnóstico , Traumatismos em Atletas/tratamento farmacológico , Traumatismos em Atletas/patologia , Traumatismos em Atletas/fisiopatologia , Transtornos Traumáticos Cumulativos/tratamento farmacológico , Transtornos Traumáticos Cumulativos/patologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Diagnóstico Diferencial , Humanos , Traumatismos da Perna/tratamento farmacológico , Traumatismos da Perna/patologia , Traumatismos da Perna/fisiopatologia , Traumatismos dos Tendões/tratamento farmacológico , Traumatismos dos Tendões/patologia , Traumatismos dos Tendões/fisiopatologiaRESUMO
Animal bite is a bite wound from a pet, farm or wild animal. Dog bites make up 80-85% of all reported incidents. Cats amount for about 10% of reported bites and other animals such as rodents, rabbits, horses, raccoons, bats and monkeys amount to 5-10%. Bites by mongoose are uncommon. Here, we present a case of fatal mongoose bite to an elderly woman who died as a complication of streptococcal infection at the bite site.
Assuntos
Mordeduras e Picadas/complicações , Herpestidae , Traumatismos da Perna/diagnóstico , Infecções Estreptocócicas/diagnóstico , Infecção dos Ferimentos/diagnóstico , Animais , Anti-Infecciosos/uso terapêutico , Mordeduras e Picadas/tratamento farmacológico , Mordeduras e Picadas/patologia , Cefoperazona/uso terapêutico , Quimioterapia Combinada , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/patologia , Humanos , Índia , Injeções , Traumatismos da Perna/tratamento farmacológico , Traumatismos da Perna/patologia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Pele/patologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/patologia , Sulbactam/uso terapêutico , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/patologiaRESUMO
INTRODUCTION: Painful extremity injuries are common patient complaints in resort clinics, urgent care clinics, and emergency departments. We hypothesized that intranasal (IN) sufentanil could provide rapid, noninvasive, effective pain relief to patients presenting with acute extremity injuries. METHODS: This was an unblinded, nonrandomized, observational study that enrolled a convenience sample of patients presenting to a university-affiliated ski clinic with acute moderate to severe pain associated with a traumatic injury between the months of January and March 2011. Patients were excluded if they reported an allergy to sufentanil or had hypoxia, significant head injury, or hypotension. Nurses administered IN sufentanil using an IN atomizer device. The nurse recorded patient-reported pain scores (0-10 scale) on arrival and at 10, 20, and 30 minutes after administration of sufentanil. RESULTS: During the study period, 40 patients were enrolled; 75% were men. The average age was 32 years (range, 16-60 years). The average dose of sufentanil was 37.7 µg. Five patients (12.5%) were given additional IN analgesia. Average pain on arrival was 9 (on a 10-point scale), and the mean reduction in pain scores was 4.7 (95% confidence interval [CI], 3.67-5.57) at 10 minutes, 5.79 (95% CI, 4.81-6.77) at 20 minutes, and 5.74 (95% CI, 4.72-6.76) at 30 minutes. CONCLUSION: In this limited observational trial, IN sufentanil provided rapid, safe, and noninvasive pain relief to patients presenting with acute traumatic extremity injuries. Given the ease of administration, this may serve as a viable option for use in other settings, such as urgent care clinics and emergency departments.
Assuntos
Dor Aguda/terapia , Analgésicos Opioides/uso terapêutico , Esqui/lesões , Sufentanil/uso terapêutico , Administração Intranasal , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Traumatismos do Braço/tratamento farmacológico , Feminino , Humanos , Traumatismos da Perna/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor , Sufentanil/administração & dosagem , Adulto JovemRESUMO
Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the past 28 years. This failure is most likely due to the following: 1) an over-reliance on treating the symptoms of injury, such as subjective measures of "pain", with drugs and interventions; 2) the risk factors investigated for hamstring injuries have not been related to the actual movements that cause hamstring injuries i.e. not functional; and, 3) a multi-factorial approach to assessment and treatment has not been utilized. The purpose of this clinical commentary is to introduce a model for progression through a return-to-sport rehabilitation following an acute hamstring injury. This model is developed from objective and quantifiable tests (i.e. clinical and functional tests) that are structured into a step-by-step algorithm. In addition, each step in the algorithm includes a treatment protocol. These protocols are meant to help the athlete to improve through each phase safely so that they can achieve the desired goals and progress through the algorithm and back to their chosen sport. We hope that this algorithm can serve as a foundation for future evidence based research and aid in the development of new objective and quantifiable testing methods.
Assuntos
Algoritmos , Traumatismos em Atletas/reabilitação , Traumatismos da Perna/reabilitação , Músculo Esquelético/lesões , Medicina Esportiva , Coxa da Perna/lesões , Doença Aguda , Anti-Inflamatórios não Esteroides , Traumatismos em Atletas/tratamento farmacológico , Crioterapia , Humanos , Hidroterapia , Traumatismos da Perna/tratamento farmacológico , Força Muscular , Modalidades de Fisioterapia , Maleabilidade , Amplitude de Movimento ArticularRESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequently isolated bacteria in wound cultures. MRSA has been linked to lengthened wound healing times, an increase in adverse postoperative outcomes, and mortality. This study investigated the incidence of MRSA in lower extremity wounds and examined outcomes associated with MRSA-infected wounds versus non-MRSA-infected wounds. A retrospective study was conducted. Patients with MRSA-infected wounds were compared with those with uninfected wounds in a 1:2 ratio. Demographics, infection, and stay information were collected. Data were analyzed using SPSS 15.0. 51 patients were included (17 with MRSA and 34 without MRSA). Patients with MRSA had increased lengths of stay and a higher incidence of adverse postoperative outcomes compared with non-MRSA patients. An MRSA infection adversely affects a patient's hospital course. Preoperative screening for MRSA and postoperative surveillance should be considered to prevent and eliminate the spread of this virulent bacterium.
Assuntos
Traumatismos da Perna/microbiologia , Resistência a Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Infecção dos Ferimentos/tratamento farmacológico , Feminino , Humanos , Traumatismos da Perna/tratamento farmacológico , Tempo de Internação , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
We present a case of multiple lacerations occurring from an encounter with a bull shark in which violent contact was made with the animal's rough skin. Conservative treatment of the injury resulted in good clinical outcome without any complications. Such events are only rarely reported in the medical literature.
Assuntos
Lacerações/etiologia , Traumatismos da Perna/etiologia , Tubarões , Animais , Bandagens , Terapia Combinada , Desbridamento , Humanos , Traumatismos da Perna/tratamento farmacológico , Traumatismos da Perna/cirurgia , Traumatismos da Perna/terapia , Masculino , Pessoa de Meia-Idade , Mupirocina/uso terapêutico , PressãoRESUMO
Patients with low-trauma fractures are at risk of future fractures and so should be evaluated and treated for osteoporosis. This study was conducted to assess and compare bone medication use and calcium and vitamin D intake at the time of and after an acute fracture. One hundred and six patients, mean age 66.7+/-10.3 years, were administered medical history and diet questionnaires at enrollment (in an urban hospital) and again 6 and 12 months later (by telephone). Of 86 patients who could be contacted 6 months after their fracture, 36.2% of the women and 7.4% of the men had recently discussed osteoporosis with their primary care doctor. At 6 months, 24.2% of the women and 3.6% of the men were taking bone medications (compared with 27.8% and 3.6% before the fracture; NS). At 6 months, 52.6% of the women and 10.7% of the men indicated that their doctor had recently recommended calcium or vitamin D. Among the women who had recently been advised by their primary care doctor to use calcium or vitamin D, supplement use increased from 63.3% to 90.0% (P = 0.021) and dairy food intake increased from 1.5+/-1.1 to 2.4+/-1.9 servings/day (P = 0.016). Only three men received this advice and two of them heeded it. Among women and men not receiving this advice, there was no significant increase in calcium supplement use or dairy food intake. At 12 months, the treatment profiles were unchanged from 6 months and 9.6% of the women and 4.3% of the men had had another fracture. In conclusion, the occurrence of a fracture did not increase likelihood of pharmacologic treatment for osteoporosis. After their fractures, the women did increase their intake of calcium supplements and dairy foods when this was recommended by their doctor. This suggests that the primary care physician is well positioned to bring about much needed change in the quality of care of fracture patients.