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1.
Enferm. foco (Brasília) ; 11(5): 67-72, dez. 2020. ilus, tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1177216

RESUMO

Objetivo: Analisar as prescrições de curativo realizadas por enfermeiros e médicos quanto a clareza e a adequabilidade do produto prescrito as características da ferida, bem como analisar as implicações éticas desse contexto. Metodologia: Estudo descritivo quantitativo, realizado em um hospital universitário do Centro-Oeste brasileiro. Compuseram a amostra 180 prescrições de curativos obtidas em prontuários de pacientes com feridas, e as características das feridas foram coletadas por meio de instrumento tipo checklist. Resultados: 92,2% dos registros apresentavam prescrições para a realização dos curativos. Em 7,8% dos registros não havia prescrição de curativos. 93,9% das prescrições estavam incompletas, sendo que em 31,4% foi encontrado divergência entre prescrições de enfermagem e médica no mesmo registro diário. Em 32,3% não havia especificação do produto a ser utilizado no curativo. Em 38,3% a prescrição do produto foi inadequada às características das feridas. Conclusão: Foram evidenciadas fragilidades nas prescrições de curativo que implicam infrações éticas. Os achados reforçam a necessidade de capacitação da equipe e maiores investimentos na formação do profissional em tratamento de feridas. (AU)


Objective: To analyze the dressing prescriptions made by nurses and doctors regarding the clarity and suitability of the prescribed product to the characteristics of the wound, as well as to analyze the ethical implications of this context. Methods: Quantitative descriptive study, carried out in a university hospital in the Brazilian Midwest. The sample comprised 180 dressing prescriptions obtained from medical records of patients with wounds, and the characteristics of the wounds were collected using a checklist-type instrument. Results: 92.2% of the records had prescriptions for dressing. In 7.8% of the records there was no prescription for dressings. 93.9% of prescriptions were incomplete, and in 31.4% there was a divergence between nursing and medical prescriptions in the same daily record. In 32.3% there was no specification of the product to be used in the dressing. In 38.3% the prescription of the product was inadequate to the characteristics of the wounds. Conclusion: Weaknesses in dressing prescriptions that imply ethical infractions were evidenced. The findings reinforce the need for staff training and greater investments in training professionals in wound care. (AU)


Objetivo: Analizar las prescripciones de apósitos realizadas por enfermeras y médicos sobre la claridad e idoneidad del producto prescrito a las características de la herida, así como analizar las implicaciones éticas de este contexto. Métodos: Estudio descriptivo cuantitativo, realizado en un hospital universitario del Medio Oeste brasileño. La muestra estuvo fue compuesta por 180 prescripciones de apósitos obtenidas de historias clínicas de pacientes con heridas, y las características de las heridas se recolectaron mediante un instrumento tipo checklist. Resultados: el 92,2% de los registros tenía prescripción de aposito. En el 7,8% de los registros no había prescripción de apósitos. El 93,9% de las prescripciones estaban incompletas y en el 31,4% había divergencia entre las prescripciones médicas y de enfermería en un mismo registro diario. En el 32,3% no se especificó el producto a utilizar en el apósito. En el 38,3% la prescripción del producto fue inadecuada a las características de las heridas. Conclusión: Se evidenciaron debilidades en la preparación de prescripciones que implican infracciones éticas. Los hallazgos refuerzan la necesidad de capacitación del personal y mayores inversiones en la capacitación de profesionales en el cuidado de heridas. (AU)


Assuntos
Curativos Oclusivos , Ferimentos e Lesões , Registros Médicos , Prescrições , Técnicas de Fechamento de Ferimentos
2.
Rev. enferm. UERJ ; 28: e42285, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1120154

RESUMO

Objetivo: comparar o custo entre coberturas com filme transparente versus gaze estéril e fita adesiva microporosa em curativos de acesso venoso central. Método: estudo estatístico, prospectivo, observacional, com abordagem quantitativa à luz da avaliação econômica de saúde. Foram avaliadas 109 coberturas com filme e 168 com gaze, durante 27 dias. Na análise utilizouse o Software Tree Age para se calcular a probabilidade de cada decisão. Resultado: a média de uso das coberturas por dia foi de 2,22 inserções cobertas com filme e 3,43 com gaze. Houve necessidade de troca extra em 38 (23%) das coberturas com gaze e em 16 (15%) das coberturas com filme transparente. Observou-se custo final médio para gaze (R$389,44) 3,7 vezes maior que o filme transparente (R$104,95) durante o período estudado. Conclusão: cobertura com filme transparente tem menor custo quando comparado com cobertura com gaze estéril.


Objective: to compare the cost of transparent film and sterile gauze fixed by microporous adhesive tape in central venous access dressings. Method: quantitative, prospective, observational, statistical study in the light of health economics. A total of 109 film and 168 gauze covers were evaluated for 27 days. Tree Age software was used to calculate the probability of each decision. Results: coverings used per day averaged 2.22 with transparent film-covered inserts and 3.43 with gauze. Additional changes were necessary in 38 (23%) coverings with gauze and 16 (15%) with transparent film. During the study period, the average final cost of gauze (R$ 389.44) was 3.7 times higher than transparent film (R$104.95). Conclusion: transparent film dressing is less expensive than sterile gauze covering.


Objetivo: comparar el costo de la película transparente y la gasa estéril fijada con cinta adhesiva microporosa en apósitos de acceso venoso central. Método: estudio cuantitativo, prospectivo, observacional, estadístico a la luz de la economía de la salud. Se evaluaron un total de 109 películas y 168 cubiertas de gasa durante 27 días. Se utilizó el software Tree Age para calcular la probabilidad de cada decisión. Resultados: los recubrimientos utilizados por día promediaron 2,22 con inserciones transparentes recubiertas con película y 3,43 con gasas. Fueron necesarios cambios adicionales en 38 (23%) revestimientos con gasa y 16 (15%) con película transparente. Durante el período de estudio, el costo final promedio de la gasa (R $ 389,44) fue 3,7 veces superior al de la película transparente (R $ 104,95). Conclusión: el apósito de película transparente es menos costoso que el recubrimiento de gasa estéril.


Assuntos
Humanos , Avaliação em Saúde/economia , Cateteres Venosos Centrais , Curativos Oclusivos/economia , Brasil , Árvores de Decisões , Estudos Prospectivos , Custos e Análise de Custo , Estudo Observacional , Curativos Oclusivos/estatística & dados numéricos
3.
Cir. plást. ibero-latinoam ; 46(4): 483-488, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198736

RESUMO

Presentamos un caso en el que empleamos con éxito plasma rico en plaquetas heterólogo (PRPh) para la reparación de una quemadura de difícil evolución en un paciente pediátrico. Mostramos la seguridad y eficacia del uso del PRPh proveniente de la madre en un caso de quemadura AB-A por agua caliente. Se trata de una paciente de 3 años de edad que fue intervenida quirúrgicamente en otro centro, sin resultados positivos y profundizándose, por lo que se vio complicada su recuperación. El objetivo fue regenerar el tejido afectado e inducir de manera asistida la formación de tejido epitelial utilizando PRPh de la madre de la paciente. Aplicamos técnica de curación cerrada en 2 sesiones ambulatorias mediante la aplicación de PRPh sin necesidad de procedimientos adicionales. No se presentaron complicaciones, signos de rechazo ni infecciones y la recuperación se obtuvo en 14 días


The safety and efficacy of the use of heterologous rich platelet plasma (hRPP) from the mother is shown in a case of AB-A burn by hot water. This is a 3-year-old patient who was surgically operated in another center, without positive results and deepening, so recovery was complicated. The objective was to regenerate the affected tissue and to induce in an assisted way the formation of epithelial tissue using hRPP from the patient's mother. We apply the closed healing technique in 2 outpatient sessions by applying hRPP without the need for additional procedures. There were no complications, signs of rejection or infections, and their recovery was obtained in 14 days


Assuntos
Humanos , Feminino , Pré-Escolar , Queimaduras/terapia , Plasma Rico em Plaquetas , Resultado do Tratamento , Regeneração , Segurança do Paciente , Rifampina/administração & dosagem , Curativos Oclusivos , Terapia Baseada em Transplante de Células e Tecidos/métodos , Cicatrização , Administração Tópica
4.
Metas enferm ; 23(8): 50-58, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196932

RESUMO

OBJETIVO: evaluar la eficacia del uso de un aerosol protector barrera para la prevención de la maceración e irritación de la piel periestomal, en el paciente quirúrgico, antes de la colocación de los discos, y valorar la eficacia de la aplicación de dicho aerosol previo a la retirada de los adhesivos. MÉTODO: se llevó a cabo un ensayo clínico aleatorizado con dos grupos de comparación: grupo control (cura habitual) y grupo experimental (cura habitual + aplicación de aerosol como método barrera antes de la colocación del disco y spray quita-adhesivo para su retirada). Se incluyeron a los pacientes ostomizados en el Hospital Universitario Infanta Cristina (Parla, Madrid) en 2019, atendidos en la Consulta de Cirugía General. Se aleatorizaron a dos grupos, 15 por grupo. Se recogieron variables descriptivas el día de la captación y de resultado a los 10 días del seguimiento. Se llevaron a cabo análisis univariante y bivariante. La relación entre las distintas variables se evaluó mediante pruebas estadísticas. RESULTADOS: se aleatorizaron 30 pacientes, 15 en grupo control y 15 en grupo experimental. Se observaron diferencias clínicas en los grupos de comparación al inicio del estudio. Al comparar las variables de resultado a los 10 días de la cirugía en los dos grupos del estudio, se observaron diferencias estadísticamente significativas en la presencia de complicaciones en la piel periestomal (p< 0,001) con un 80% (n= 12) en el grupo control frente al 6,7% (n= 1) en el grupo experimental, y en el tipo de complicaciones entre ambos grupos (0,002), destacando las lesiones de tipo L2 Erosivas. CONCLUSIONES: la utilización tanto de un aerosol protector barrera sobre la piel del paciente antes de la colocación del disco de ostomías como la aplicación para su retirada de un spray quita-adhesivo, parece reducir el riesgo de complicaciones en la piel periestomal en el paciente quirúrgico


OBJECTIVES: to assess the efficacy of using a protective barrier spray for preventing peristomal skin maceration and irritation in surgical patients before disc placement, and to assess the efficacy of the application of said spray before removing the adhesive discs. METHOD: a randomized clinical trial was conducted with two comparison arms: the control group (standard cure) and the experimental arm (standard cure + application of spray as barrier method before disc placement and adhesive remover spray for removing them). The study included ostomized patients from the Hospital Universitario Infanta Cristina (Parla, Madrid) in 2019, seen at the General Surgery Unit. Patients were randomly assigned to two 15-patient arms. Descriptive variables were collected on recruitment day, and for outcomes at 10 days follow-up. Univariate and bivariate analyses were conducted. The relationship between different variables was evaluated through statistical tests. RESULTS: thirty (30) patients were randomized, 15 patients to the control arm and 15 patients to the experimental arm. Clinical differences were observed in the comparison arms at study initiation. When comparing the outcome variables at 10 days after surgery in the two study arms, statistically significant differences were observed regarding the presence of complications in the peristomal skin (p< 0.001) with 80% (n= 12) in the control arm vs. 6.7% (n= 1) in the experimental arm, and in terms of type of complications between both arms (0,002), particularly L2-type erosive lesions. CONCLUSIONS: the use of a protective barrier spray on the skin of the patient before placing the ostomy disc as well as the application of an adhesive remover spray for removal seems to reduce the risk of complications in the peristomal skin of surgical patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estomia/enfermagem , Curativos Oclusivos , Traumatismos Abdominais/enfermagem , Supuração/enfermagem , Transtornos da Pigmentação/prevenção & controle , Ileostomia/enfermagem , Complicações Pós-Operatórias/enfermagem , Enfermagem de Centro Cirúrgico , Supuração/prevenção & controle
5.
Isr Med Assoc J ; 9(22): 476-480, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954692

RESUMO

BACKGROUND: Neonatal hypothermia (< 36°C) has been associated with both neonatal morbidity and mortality. OBJECTIVES: To develop a multifactorial approach to reduce the incidence of neonatal hypothermia at admission to the neonatal intensive care unit. METHODS: The approach involved a detailed quality improvement (QI) plan, which included the use of occlusive wrapping and exothermic mattresses as well as higher delivery and operating room environmental temperatures. The improvement plan was implemented over a 10-month period. Retrospective comparison to the same 10-month period during the previous year assessed the effectiveness of the approach in reducing the incidence of admission hypothermia. RESULTS: The QI project included 189 patients. These patients were compared to 180 patients during the control period. The characteristics of the patient groups were similar and included preterm infants, who were subsequently analyzed as a subgroup. We found a significant reduction in the incidence of hypothermia, which was most profound for the subgroup of premature infants born at < 32 weeks gestation. Neonatal hyperthermia was identified as an unintended consequence of the project, and subsequently improved after initiating simple preventive measures. CONCLUSIONS: Occlusive wrapping, exothermic mattresses, and higher delivery and operating room environmental temperature may be successful in reducing admission neonatal hypothermia.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Hipotermia/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Roupas de Cama, Mesa e Banho , Humanos , Hipotermia/epidemiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Israel , Curativos Oclusivos , Salas Cirúrgicas , Melhoria de Qualidade , Temperatura
6.
Handchir Mikrochir Plast Chir ; 52(3): 189-191, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32531785

RESUMO

PURPOSE: This study aims to analyse how the confidence of patients with a fingertip injury treated with a semi-occlusive dressing develops during treatment. In addition, the development of odour emission was recorded. PATIENTS AND METHODS: 17 patients with a fingertip injury were treated by use of a semi-occlusive dressing. On each appointment, before the dressing was changed, patients were interviewed about their confidence in the type of treatment and the amount of odour emission. Confidence in type of treatment and amount of odour emission were graded on a numeric analogue scale with 0 = no confidence and 10 = absolute confidence, and 0 = no odour emission and 10 = extreme odour emission, respectively. After the fingertip injury healed, pulp thickness was measured by ultrasound and compared with the uninjured finger of the opposite hand. RESULTS: Already at the beginning of treatment, patient confidence in the type of treatment was high (8.5 ± SD 1.1). Odour emission reached a maximum of 5.6 ± SD 2.5 at the third dressing change. As odour emission decreased, confidence in type of treatment peaked between the third and fourth dressing change. After healing of the fingertip injury, the pulp of the injured finger was measured to be 3.0 ± 0.6 mm on ultrasound; pulp thickness of the uninjured finger of the other hand was 3.4 ± 0.8 mm. CONCLUSION: The confidence that a fingertip injury will heal by use of a semi-occlusive dressing is very high from the beginning of treatment. As odour emission decreases, confidence in treatment increases further.


Assuntos
Traumatismos dos Dedos/terapia , Curativos Oclusivos , Bandagens , Humanos , Odorantes , Cicatrização
7.
Am Surg ; 86(3): 176-183, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223794

RESUMO

Before Joseph Lister's landmark Lancet publications on the use of carbolic acid wound dressings in 1867, surgeons Jules Lemaire in France and Enrico Bottini in Italy had already used carbolic acid on hundreds of patients to control suppurative wounds. After Friedlieb Runge isolated it from coal tar in 1834, a number of scientists recognized the efficacy of carbolic acid in preventing decay and neutralizing the stench of dead animals and human cadavers. Frederick Calvert, Alexander McDougall, and Angus Smith in Manchester promoted a powdered form of carbolic acid as a deodorizing agent to treat municipal sewage across the United Kingdom, most notably during London's famous "Great Stink" of 1858. Edmond Corne in France introduced his formulation, which Alfred-Armand-Louis-Marie Velpeau, Ferdinand LeBeuf, and Lemaire adapted for clinical use in 1859. Lemaire wrote extensively on carbolic acid and its surgical application in three publications from 1860 to 1862. In 1866, Bottini published his experience of 600 cases where it was used. In 1865, Lister began to use carbolic acid in open fractures after Thomas Anderson, his colleague in agricultural chemistry at the University of Glasgow, told him about its use in Carlisle sewage works. This article traces the rich history of carbolic acid from an unknown compound in coal to the cornerstone of Listerism in late-19th-century operating rooms.


Assuntos
Curativos Oclusivos , Fenol/uso terapêutico , Infecção da Ferida Cirúrgica/prevenção & controle , Ferida Cirúrgica/terapia , História do Século XIX , Humanos , Cicatrização/fisiologia
8.
Carbohydr Polym ; 235: 115953, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32122489

RESUMO

Adhesion loss of hydrocolloid wound dressings is ubiquitous clinical problem, which seriously reduces the therapeutic efficiency and patient experience. In order to address this problem, the clarification on adhesion loss mechanism and the development of effective alternatives of commercial hydrocolloid dressings are urgent and inevitable. Herein, adhesion loss mechanism of hydrocolloid dressings was investigated using sodium carboxymethyl cellulose (CMC)-filled hydrocolloid dressings exposing to physiological environment as model. The adhesion mechanism and contact angle tests were combined to obtain surface energy of dressings. The results indicated that the dissolution, swelling and exudation of CMC occurred successively (concentration reached 1.607 g/L after 10 h). The effused CMC led to the dramatic increase in surface energy (from 14.5-80.7 mN/m) and adhesion loss appeared. This work explored the origin of adhesion loss of hydrocolloid wound dressings and might promote the designing of hydrocolloid dressings with both excellent humidity control and sustained self-adhesiveness.


Assuntos
Curativos Hidrocoloides , Carboximetilcelulose Sódica/química , Curativos Oclusivos , Pele/química , Adesividade , Humanos , Tamanho da Partícula , Propriedades de Superfície , Aderências Teciduais , Cicatrização
9.
Cochrane Database Syst Rev ; 3: CD005136, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32203629

RESUMO

BACKGROUND: Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation of a clear image on the retina. SDA can be resistant to treatment, leading to poor visual prognosis. SDA probably constitutes less than 3% of all amblyopia cases, although precise estimates of prevalence are unknown. In high-income countries, most people present under the age of one year; in low- to middle-income countries, people are likely to be older at the time of presentation. The mainstay of treatment is correction of the obstruction (e.g., removal of the cataract) and then occlusion of the better-seeing eye, but regimens vary, can be difficult to execute, and traditionally are believed to lead to disappointing results. OBJECTIVES: To evaluate the effectiveness of occlusion therapy for SDA in an attempt to establish realistic treatment outcomes and to examine evidence of any dose-response effect and assess the effect of the duration, severity, and causative factor on the size and direction of the treatment effect. SEARCH METHODS: We searched CENTRAL (2018, Issue 12), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; and five other databases. We used no date or language restrictions in the electronic searches. We last searched the databases on 12 December 2018. SELECTION CRITERIA: We planned to include randomized controlled trials (RCTs) and controlled clinical trials of participants with unilateral SDA with visual acuity worse than 0.2 LogMAR or equivalent. We specified no restrictions for inclusion based upon age, gender, ethnicity, comorbidities, medication use, or the number of participants. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. MAIN RESULTS: We identified no trials that met the inclusion criteria specified in the protocol for this review. AUTHORS' CONCLUSIONS: We found no evidence from RCTs or quasi-randomized trials on the effectiveness of any treatment for SDA. RCTs are needed in order to evaluate the safety and effectiveness of occlusion, duration of treatment, level of vision that can be realistically achieved, effects of age at onset and magnitude of visual defect, optimum occlusion regimen, and factors associated with satisfactory and unsatisfactory outcomes with the use of various interventions for SDA.


Assuntos
Ambliopia/terapia , Curativos Oclusivos , Ambliopia/etiologia , Blefaroptose/complicações , Catarata/complicações , Pré-Escolar , Humanos , Lactente , Resultado do Tratamento
10.
Cochrane Database Syst Rev ; 1: CD001836, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-31978262

RESUMO

BACKGROUND: It is estimated that up to 1% of people in high-income countries suffer from a leg ulcer at some time in their life. The majority of leg ulcers are associated with circulation problems; poor blood return in the veins causes venous ulcers (around 70% of ulcers) and poor blood supply to the legs causes arterial ulcers (around 22% of ulcers). Treatment of arterial leg ulcers is directed towards correcting poor arterial blood supply, for example by correcting arterial blockages (either surgically or pharmaceutically). If the blood supply has been restored, these arterial ulcers can heal following principles of good wound-care. Dressings and topical agents make up a part of good wound-care for arterial ulcers, but there are many products available, and it is unclear what impact these have on ulcer healing. This is the third update of a review first published in 2003. OBJECTIVES: To determine whether topical agents and wound dressings affect healing in arterial ulcers. To compare healing rates and patient-centred outcomes between wound dressings and topical agents. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 28 January 2019. SELECTION CRITERIA: Randomised controlled trials (RCTs), or controlled clinical trials (CCTs) evaluating dressings and topical agents in the treatment of arterial leg ulcers were eligible for inclusion. We included participants with arterial leg ulcers irrespective of method of diagnosis. Trials that included participants with mixed arterio-venous disease and diabetes were eligible for inclusion if they presented results separately for the different groups. All wound dressings and topical agents were eligible for inclusion in this review. We excluded trials which did not report on at least one of the primary outcomes (time to healing, proportion completely healed, or change in ulcer area). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted information on the participants' characteristics, the interventions, and outcomes using a standardised data extraction form. Review authors resolved any disagreements through discussion. We presented the data narratively due to differences in the included trials. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Two trials met the inclusion criteria. One compared 2% ketanserin ointment in polyethylene glycol (PEG) with PEG alone, used twice a day by 40 participants with arterial leg ulcers, for eight weeks or until healing, whichever was sooner. One compared topical application of blood-derived concentrated growth factor (CGF) with standard dressing (polyurethane film or foam); both applied weekly for six weeks by 61 participants with non-healing ulcers (venous, diabetic arterial, neuropathic, traumatic, or vasculitic). Both trials were small, reported results inadequately, and were of low methodological quality. Short follow-up times (six and eight weeks) meant it would be difficult to capture sufficient healing events to allow us to make comparisons between treatments. One trial demonstrated accelerated wound healing in the ketanserin group compared with the control group. In the trial that compared CGF with standard dressings, the number of participants with diabetic arterial ulcers were only reported in the CGF group (9/31), and the number of participants with diabetic arterial ulcers and their data were not reported separately for the standard dressing group. In the CGF group, 66.6% (6/9) of diabetic arterial ulcers showed more than a 50% decrease in ulcer size compared to 6.7% (2/30) of non-healing ulcers treated with standard dressing. We assessed this as very-low certainty evidence due to the small number of studies and arterial ulcer participants, inadequate reporting of methodology and data, and short follow-up period. Only one trial reported side effects (complications), stating that no participant experienced these during follow-up (six weeks, low-certainty evidence). It should also be noted that ketanserin is not licensed in all countries for use in humans. Neither study reported time to ulcer healing, patient satisfaction or quality of life. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether the choice of topical agent or dressing affects the healing of arterial leg ulcers.


Assuntos
Úlcera da Perna/terapia , Pomadas/uso terapêutico , Cicatrização , Administração Tópica , Artérias , Curativos Hidrocoloides , Humanos , Curativos Oclusivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Úlcera Varicosa/terapia
12.
J Vasc Surg Venous Lymphat Disord ; 8(1): 106-109, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31843245

RESUMO

OBJECTIVE: Whereas the commonly described manifestations of venous insufficiency include telangiectasia, varicose veins (VVs), edema, skin changes, and ulcers, we have noted some patients who present with external hemorrhage from lower extremity VVs. Because there are few recent data examining this entity, we herein describe our experience. METHODS: During 29 months, we had 32 patients present with hemorrhage from lower extremity VVs. There were 15 men and 17 women with a mean age of 60.2 years (range, 38-89 years; standard deviation [SD], ±14.9 years). Interestingly, 16 of these patients presented after coming into contact with warm water; 28 patients, 19 patients, and 1 patient presented with reflux >500 milliseconds in the great, small, and accessory saphenous veins, respectively. Eight patients and six patients had reflux >1 second in the femoral and popliteal veins, respectively. RESULTS: All patients were treated with weekly Unna boots. Mean ulcer healing time was 2.12 weeks (range, 1-8 weeks; SD, ± 2.15 weeks). Patients with VV hemorrhage after contact with warm water had a mean healing time of 1.75 weeks, whereas those who bled without such exposure took an average of 3.5 weeks (P = .0426). Twenty patients underwent at least one endovenous thermal ablation procedure, with the average patient in the cohort receiving 2.16 procedures (range, 0-9; SD, ± 2.37). There was no significant difference between laterality, age, or sex between patients who bled after warm water contact and those who bled spontaneously. The ulcers recurred in three of the patients, and Unna boot treatment was reapplied until wounds healed once more. Patients had an average follow up of 7.2 months (range, 26 months; SD, ± 8.9 months), and we noted no recurrent bleeding episodes. CONCLUSIONS: Spontaneous hemorrhage of VVs, although relatively under-reported, is not a rare occurrence. Risk factors are unknown; however, half of our patient cohort reported VV hemorrhage during or directly after coming into contact with warm water. Furthermore, these patients demonstrated a significantly shorter wound healing time compared with the rest of the cohort. Basic first aid, wound care, and hemostasis control education should be provided to all patients with VVs. Further investigation surrounding the risk factors associated with VV hemorrhage is warranted.


Assuntos
Hemorragia/etiologia , Varizes/etiologia , Insuficiência Venosa/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Hemorragia/terapia , Técnicas Hemostáticas , Humanos , Masculino , Pessoa de Meia-Idade , Curativos Oclusivos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/terapia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/terapia , Cicatrização
13.
J Am Acad Dermatol ; 82(4): 895-901, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31589946

RESUMO

BACKGROUND: Occlusive treatments are a mainstay in atopic dermatitis (AD) management but may not be well tolerated or lack compliance. A comfortable, semiocclusive, artificial skin barrier that is well tolerated, provides protection, and reduces water loss is needed. OBJECTIVE: To evaluate the potential tolerability and therapeutic benefits of a crosslinked polymer layer (XPL) in adults with AD. METHODS: A single-center, open-label pilot study was conducted involving 10 subjects with moderate to severe AD. Subjects applied XPL up to twice daily for 30 days on a selected treatment area. Investigator's Global Assessment, clinical signs of eczema, and pruritus were assessed on days 1, 3, 5, 15, and 30. Film durability and patient satisfaction were also evaluated. RESULTS: Investigator's Global Assessment scores improved from moderate to severe at baseline to clear to almost clear in 8 of 9 patients at day 30. Pruritus improved from trace to severe itching (baseline) to all subjects having trace to no itching at day 30. There was 1 adverse event of mild exudative dermatitis. LIMITATIONS: The study was limited by small sample size, open-label design, and lack of control. CONCLUSION: XPL may be an effective adjuvant in AD treatment. A larger study with a control group is warranted.


Assuntos
Dermatite Atópica/terapia , Curativos Oclusivos , Polímeros/administração & dosagem , Prurido/terapia , Administração Cutânea , Adulto , Reagentes para Ligações Cruzadas , Dermatite Atópica/complicações , Dermatite Atópica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Polímeros/química , Prurido/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
15.
J Dermatol ; 47(1): 25-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31657024

RESUMO

Crisaborole ointment, 2%, is a non-steroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD). This parallel-cohort, phase 1 study was conducted to investigate skin irritation potential and safety of crisaborole in healthy Japanese adults (cohort 1) and the safety and pharmacokinetic profile of crisaborole and metabolites AN7602 and AN8323 in Japanese adults with mild to moderate AD (cohort 2). In cohort 1, 20 healthy volunteers received single applications of crisaborole and vehicle simultaneously on separate locations under 48-h occlusion. In cohort 2, 12 patients with mild to moderate AD received crisaborole (n = 10) or vehicle (n = 2) twice daily for 8 days. Skin irritation and safety were assessed in cohort 1. Pharmacokinetics and safety were assessed in cohort 2. Skin irritation index (scale 0-400) was 40.0 for crisaborole and 5.0 for vehicle. No treatment-emergent adverse events (TEAE) were reported in cohort 1. The most common TEAE in the crisaborole group in cohort 2 were application site irritation (n = 7) and application site pain (n = 4). Crisaborole was rapidly absorbed, with limited systemic exposure between days 1 and 8 that was comparable with that seen in US-based participants in previous trials. Crisaborole had higher skin irritation than vehicle under occlusion in healthy Japanese adults and had an acceptable safety profile in Japanese adults with mild to moderate AD.


Assuntos
Compostos de Boro/administração & dosagem , Compostos de Boro/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Dermatite Atópica/tratamento farmacológico , Inibidores da Fosfodiesterase 4/administração & dosagem , Inibidores da Fosfodiesterase 4/efeitos adversos , Administração Cutânea , Adulto , Compostos de Boro/farmacocinética , Compostos Bicíclicos Heterocíclicos com Pontes/farmacocinética , Método Duplo-Cego , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Curativos Oclusivos , Pomadas , Inibidores da Fosfodiesterase 4/farmacocinética , Método Simples-Cego , Dermatopatias/induzido quimicamente , Resultado do Tratamento , Adulto Jovem
17.
J Cosmet Dermatol ; 19(2): 416-422, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31175696

RESUMO

BACKGROUND: Warts are common viral skin infections caused by human papillomavirus. None of the available treatment modalities fulfills the criteria of an ideal treatment option. OBJECTIVES: To evaluate the efficacy and safety of hydrogen peroxide (HP) 3% and 6% solution as a topical treatment of nongenital warts. METHODS: This prospective randomized controlled study included 145 patients with nongenital warts. They were divided into three groups. Group 1 used topical hydrogen peroxide 6% solution under occlusion with a plastic tape for one hour daily for 6 weeks, group 2 used hydrogen peroxide 3% solution, and group 3 used normal saline 0.9% as a placebo. Patients were evaluated at the third and sixth weeks of treatment and 12 weeks after treatment completion. RESULTS: Treatment responses were significantly better in groups 1 and 2 than in group 3 with a better overall responses in group 1 than in group 2 (P = 0.0001*). Apart from mild hypopigmentation which was detected in only two patients in groups 1 and 2, no other side effects could be detected. Three months after treatment completion, no recurrence was observed. CONCLUSION: Hydrogen peroxide solution (3% and 6%) is an effective, safe, and cheap treatment modality for nongenital warts which can be used simply at home. Since the overall response was better with the 6% concentration, it should be the better therapeutic option.


Assuntos
Peróxido de Hidrogênio/administração & dosagem , Oxidantes/administração & dosagem , Verrugas/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Humanos , Peróxido de Hidrogênio/efeitos adversos , Hipopigmentação/induzido quimicamente , Hipopigmentação/epidemiologia , Masculino , Pessoa de Meia-Idade , Curativos Oclusivos , Oxidantes/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
18.
J Plast Surg Hand Surg ; 54(1): 33-39, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31502914

RESUMO

Recessive dystrophic epidermolysis bullosa (RDEB) is a congenital disease caused by a mutation in the COL7A1 gene and frequently results in hand contractures and pseudosyndactyly. Although multiple treatments exist that can improve the hand malformations, there are currently still no radical cures for this disease because of its high recurrence rate. The present study reports our experiences on how to improve hand deformities in 11 RDEB patients with surgical management and postoperative skin dressings. Hand function was substantially improved after complete release of pseudosyndactyly and achievement of favorable digital web spaces. Patients were followed up for two years, and nine of which showed slight decrease in hand function characterized by re-narrowed web spaces, digit adhesion and flexed metacarpophalangeal (MP) and interphalangeal (IP) joints, while the last two patients underwent hand reoperation one year after their initial surgery because of recurrence. In conclusion, our results show that surgical correction followed by skin dressing changes is an effective approach to improving mitten-hand malformations in RDEB patients.


Assuntos
Epidermólise Bolhosa Distrófica/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Procedimentos Ortopédicos , Adolescente , Criança , Pré-Escolar , Epidermólise Bolhosa Distrófica/complicações , Feminino , Seguimentos , Deformidades Adquiridas da Mão/etiologia , Humanos , Masculino , Curativos Oclusivos , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Estudos Retrospectivos , Silicones , Contenções , Adulto Jovem
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