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1.
Am Surg ; 86(8): 950-954, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762466

RESUMO

BACKGROUND: There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. METHODS: In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. RESULTS: A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease (P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). DISCUSSION: Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.


Assuntos
Analgesia/métodos , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/tendências , Prescrição Inadequada/prevenção & controle , Padrões de Prática Médica/tendências , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia/normas , Feminino , Humanos , Prescrição Inadequada/tendências , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
2.
Arch Gynecol Obstet ; 302(2): 321-328, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32564129

RESUMO

PURPOSE: Antibiotic treatment during surgical repair of obstetric anal sphincter injuries (OASIS) had been a matter of debate. We aimed to review the available literature regarding the efficacy of metronidazole administration in women undergoing perineal repair following obstetric OASIS. STUDY DESIGN: To identify potentially eligible studies, we searched PubMed, Scopus, Embase and the Cochrane Library from inception to January 13th, 2019.Reference lists of identified studies were searched. No language restrictions were applied. We used a combination of keywords and text words represented by "Metronidazole", "obstetrics", "obstetric anal sphincter injury", "OASIS", "third degree tear", "fourth degree tear", "third degree laceration", "fourth degree laceration", "antibiotic therapy", "perineal damage" and "perineal trauma". Two reviewers independently screened the titles and abstracts of records retrieved from the database searches. Both reviewers recommended studies for the full-text review. Thescreen of full-text articles recommended by at least one reviewer was done independently by the same two reviewers and assessedfor inclusion in the systematic review. Disagreements between reviewers were resolved by consensus. RESULTS: The electronic database search yielded a total of 54,356 results (Fig. 1). After duplicate exclusion 28,154 references remained. Of them, 26 were relevant to the review based on title and abstract screening. None of these articles dealt with the use of metronidazole for the prevention of infections complicating anal sphincter repair in women with OASIS. A Cochrane review addressing antibiotic prophylaxis for patients following OASIS, compared prophylactic antibiotics against placebo or no antibiotics, included only one randomized controlled trial of 147 participants. This study showed that prophylactic antibiotics (not metronidazole) may be helpful to prevent perineal wound complications following OASIS. Fig. 1 Study seection process CONCLUSION: Anaerobic infections potentially complicate wound repair after OASIS. Although scientific societies recommend the use of antibiotics for the prevention of infectious morbidity after OASIS, no study has specifically assessed the role of metronidazole.


Assuntos
Canal Anal/lesões , Antibacterianos/uso terapêutico , Lacerações/etiologia , Metronidazol/uso terapêutico , Períneo/lesões , Infecção dos Ferimentos/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Adulto , Canal Anal/microbiologia , Antibioticoprofilaxia/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/cirurgia , Obstetrícia/métodos , Gravidez , Ferimentos e Lesões/complicações , Ferimentos e Lesões/tratamento farmacológico
3.
Khirurgiia (Mosk) ; (6): 76-81, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573536

RESUMO

OBJECTIVE: To evaluate the effectiveness of preparing a wound for plastic closure of autoskin using a negative pressure apparatus and Reamberin. MATERIAL AND METHODS: . The results of preoperative preparation of 24 patients with chronic wounds of various etiologies were analyzed. Depending on the treatment regimen, the patients were divided into groups: the main one (n=18), the patients of which were divided into subgroups: in IA (n=9) they used NPWT therapy for 5 days, in IB (n=9) it was combined with Reamberin infusions (1.5% intravenously at a rate of 40-60 drops/min, 500 ml, once a day for 5 days). Patients of the comparison group (II, n=6) received standard preparation. In the dynamics of therapy, a morpho-histological study of wound biopsies was carried out with the determination of the area of fibroblasts, the area of the nucleus of fibroblasts, the number of vessels and the determination of their diameter. After autodermoplasty, the survival of the skin flap was determined. RESULTS: It was found that the combined use of NPWT therapy and Reamberin significantly increases the effectiveness of therapy: the greatest effect on fibroblastogenesis was exerted by the inclusion of NPWT therapy in the regimen - an increase of 1.5 times compared with the results of the traditional regimen. The vascularization of the wound surface (increase in the area and diameter of blood vessels) was best influenced by the combined preparation (NPWT-therapy and Reamberin) preparations - an increase of 3.4 times in comparison with the comparison group, which affected the dynamics of the survival of the skin flap: it was 1.3 times higher than in the comparison group (p<0.01). CONCLUSIONS: The results obtained, along with good tolerability of the drug, allows us to recommend the inclusion of Reamberin in the scheme of preoperative preparation of patients with this pathology.


Assuntos
Antioxidantes/administração & dosagem , Meglumina/análogos & derivados , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Succinatos/administração & dosagem , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/cirurgia , Doença Crônica , Humanos , Infusões Intravenosas , Meglumina/administração & dosagem , Cuidados Pré-Operatórios , Transplante Autólogo , Cicatrização , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
4.
Clin Interv Aging ; 15: 763-770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32546994

RESUMO

Background: Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (<3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma patients. Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients ≥65 years admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for opioid poisoning and opioid use disorder from ICD-9 to ICD-10 code diagnosis after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not, using Cox proportional hazards regressions. Results: A total of 70,314 admissions were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3 months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.27%; 95% CI: 0.23%-0.31%) were hospitalized for opioid poisoning and 73 (0.10%; 95% CI: 0.08%-0.13%) were diagnosed with opioid use disorder. Having filled an opioid prescription within 3 months of injury was associated with an increased hazard ratio of opioid poisoning (2.8; 95% CI: 2.1-3.8) and opioid use disorder (4.2; 95% CI: 2.4-7.4) after the injury. However, history of opioid poisoning (2.6; 95% CI: 1.1-5.8), of substance use disorder (4.3; 95% CI: 2.4-7.7), or of the opioid prescription filled (2.8; 95% CI: 2.2-3.6) before the trauma, was also related to opioid poisoning or opioid use disorder after the injury. Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with a history of substance use disorder, opioid poisoning or opioid use.


Assuntos
Analgésicos Opioides , Prescrição Inadequada , Transtornos Relacionados ao Uso de Opioides , Ferimentos e Lesões/tratamento farmacológico , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/toxicidade , Canadá/epidemiologia , Feminino , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/prevenção & controle , Masculino , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Alta do Paciente/estatística & dados numéricos , Padrões de Prática Médica , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Ferimentos e Lesões/epidemiologia
5.
PLoS One ; 15(5): e0233640, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32453766

RESUMO

Understanding the coagulation process is critical to developing treatments for trauma and coagulopathies. Clinical studies on tranexamic acid (TXA) have resulted in mixed reports on its efficacy in improving outcomes in trauma patients. The largest study, CRASH-2, reported that TXA improved outcomes in patients who received treatment prior to 3 hours after the injury, but worsened outcomes in patients who received treatment after 3 hours. No consensus has been reached about the mechanism behind the duality of these results. In this paper we use a computational model for coagulation and fibrinolysis to propose that deficiencies or depletions of key anti-fibrinolytic proteins, specifically antiplasmin, a1-antitrypsin and a2-macroglobulin, can lead to worsened outcomes through urokinase-mediated hyperfibrinolysis.


Assuntos
Transtornos da Coagulação Sanguínea/tratamento farmacológico , Ácido Tranexâmico/uso terapêutico , Ativador de Plasminogênio Tipo Uroquinase/genética , Ferimentos e Lesões/tratamento farmacológico , Antifibrinolíticos/uso terapêutico , Coagulação Sanguínea/genética , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/genética , Transtornos da Coagulação Sanguínea/patologia , Simulação por Computador , Fibrina/genética , Tempo de Lise do Coágulo de Fibrina , Fibrinolisina/genética , Fibrinólise/efeitos dos fármacos , Hemorragia/sangue , Hemorragia/tratamento farmacológico , Hemorragia/genética , Humanos , Proteínas de Membrana/genética , Mortalidade , alfa 2-Macroglobulinas Associadas à Gravidez/genética , Trombina/genética , Trombina/metabolismo , Ferimentos e Lesões/sangue , Ferimentos e Lesões/genética , Ferimentos e Lesões/patologia , alfa 1-Antitripsina/genética
6.
J Trauma Acute Care Surg ; 88(6): 816-824, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459447

RESUMO

BACKGROUND: Efforts to reduce opioid use in trauma patients are currently hampered by an incomplete understanding of the baseline opioid exposure and variation in United States. The purpose of this project was to obtain a global estimate of opioid exposure following injury and to quantify the variability of opioid exposure between and within United States trauma centers. STUDY DESIGN: Prospective observational study was performed to calculate opioid exposure by converting all sources of opioids to oral morphine milligram equivalents (MMEs). To estimate variation, an intraclass correlation was calculated from a multilevel generalized linear model adjusting for the a priori selected variables Injury Severity Score and prior opioid use. RESULTS: The centers enrolled 1,731 patients. The median opioid exposure among all sites was 45 MMEs per day, equivalent to 30 mg of oxycodone or 45 mg of hydrocodone per day. Variation in opioid exposure was identified both between and within trauma centers with the vast majority of variation (93%) occurring within trauma centers. Opioid exposure increased with injury severity, in male patients, and patients suffering penetrating trauma. CONCLUSION: The overall median opioid exposure was 45 MMEs per day. Despite significant differences in opioid exposure between trauma centers, the majority of variation was actually within centers. This suggests that efforts to minimize opioid exposure after injury should focus within trauma centers and not on high-level efforts to affect all trauma centers. LEVEL OF EVIDENCE: Epidemiological, level III.


Assuntos
Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Dor/tratamento farmacológico , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos , Fatores Sexuais , Estados Unidos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
7.
J Periodontal Res ; 55(3): 464-471, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32153049

RESUMO

OBJECTIVE: To examine whether glyburide inhibits bone destruction caused by traumatic occlusion in a rat occlusal trauma model. BACKGROUND: Excessive mechanical stress, such as traumatic occlusion, induces expression of IL-1ß and may be involved in bone resorption. NLRP3 inflammasomes have been linked to IL-1ß expression, but it is currently unclear whether glyburide, the inhibiter of NLRP3 inflammasome, suppresses occlusal trauma in rats. METHODS: Male SD rats aged 7 weeks were used. In the trauma group, the occlusal surface of the maxillary first right molar was raised by attaching a metal wire to apply occlusal trauma to the mandibular first right molar. In the trauma + glyburide group, the NLRP3 inhibitor glyburide was administered orally every 24 hours from 1 day before induction of occlusal trauma. Rats were euthanized after 5 or 10 days, and the maxillary first molars were harvested with the adjacent tissues for histopathological investigation. Immunohistochemical expression of IL-1ß, NLRP3, and RANKL was also assessed. RESULTS: On day 5, bone resorption was significantly greater in the trauma group compared with the control group or the trauma + glyburide group, and there were significantly higher numbers of osteoclasts and cells positive for IL-1ß, NLRP3, and RANKL in the trauma group. CONCLUSION: In this study, glyburide inhibits bone resorption by traumatic occlusion in rats. It suggests that the NLRP3/IL-1ß pathway might be associated with bone resorption induced by traumatic occlusion.


Assuntos
Reabsorção Óssea/prevenção & controle , Oclusão Dentária , Glibureto/uso terapêutico , Ferimentos e Lesões/tratamento farmacológico , Animais , Inflamassomos , Interleucina-1beta , Masculino , Proteína 3 que Contém Domínio de Pirina da Família NLR , Ligante RANK , Ratos , Ratos Sprague-Dawley
8.
Acta Diabetol ; 57(8): 931-935, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32125532

RESUMO

AIM: Admission hyperglycemia and glucose variability were associated with mortality in critically ill patients, but data on trauma patients are to date scarce and heterogeneous. METHODS: We assessed the prognostic role of ICU death of admission and peak glycemia and glucose variability (indicated by the standard deviation of mean glucose levels and the coefficient of variation of glucose) in 252 patients consecutively admitted for trauma in our ICU (January 1, 2016-December 31, 2018). RESULTS: The in-ICU mortality rate was 17% (43/252). When compared to patients who died during ICU stay, survivors were younger (p = 0.001), more frequently males (p = 0.002), with a lower incidence of hypertension (p = 0.023). Higher values of SAPS II, SOFA and ISS were observed in nonsurvivors (p < 0.001, p < 0.001, p < 0.001, respectively). Survivors exhibited significantly lower values of admission glycemia (p = 0.001), peak glycemia (p = 0.002) and mean glucose values measured during the first 24 h since ICU admission (p = 0.001). Glucose variability was significantly higher in nonsurvivors, as indicated by higher values of SD and CV (p = 0.001 and p = 0.001, respectively). At multivariate regression analysis, admission glycemia (Model 1), peak glycemia (Model 2) and glucose variability (Model 3 and 4) were independent predictors for in-ICU mortality. CONCLUSIONS: Our findings indicate that not only admission glycemia but also peak glycemia and glucose variability show a correlation with in-ICU mortality in trauma patients.


Assuntos
Glicemia/fisiologia , Estado Terminal/mortalidade , Hiperglicemia/mortalidade , Unidades de Terapia Intensiva , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Glicemia/metabolismo , Estado Terminal/terapia , Feminino , Mortalidade Hospitalar , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Hiperglicemia/tratamento farmacológico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mortalidade , Admissão do Paciente/estatística & dados numéricos , Projetos Piloto , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Ferimentos e Lesões/sangue , Ferimentos e Lesões/tratamento farmacológico
11.
Emerg Med J ; 37(3): 135-140, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32001608

RESUMO

OBJECTIVE: To understand more about the individual variation in the time course of fibrinolysis following major injury and to assess the potential for stratification of trauma patients for tranexamic acid (TXA) therapy. METHODS: A historical dataset (from 2004) was used, consisting of samples from 52 injured patients attended by a medical prehospital system. Blood samples were taken at the incident scene, on arrival in the emergency department, 2.5 hours after hospital arrival and 5 hours after hospital arrival. From the study database, we extracted values for tissue-type plasminogen activator (tPA; an activator of fibrinolysis), one of the plasminogen activator inhibitors (PAI-1; as a natural inhibitor of fibrinolysis) and D-dimer (as a marker of the extent of fibrinolysis). RESULTS: The changes over time in median tPA and PAI-1 were mirror images, with initial high tPA levels which then rapidly decreased and low initial PAI-1 levels which slowly increased. There were high levels of fibrinolytic activity (D-dimer) throughout. This pattern was present in patients across a broad range of injury severities. CONCLUSIONS: After major trauma, there seems to be an early 'antifibrinolytic gap' with the natural antifibrinolytic system lagging several hours behind the natural profibrinolytics. An early dose of exogenous antifibrinolytic (TXA) might have its effect by filling this gap. The finding that tPA and subsequent clot breakdown (illustrated by D-dimer formation) are raised in a broad range of patients, with little correlation between the initial fibrinolytic response and markers of injury severity, may be the reason that TXA is effective across a broad range of injured patients.


Assuntos
Fibrinólise/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Adulto , Antifibrinolíticos/farmacologia , Antifibrinolíticos/uso terapêutico , Biomarcadores/análise , Biomarcadores/sangue , Sistemas de Apoio a Decisões Clínicas , Serviço Hospitalar de Emergência/organização & administração , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Inativadores de Plasminogênio/análise , Inativadores de Plasminogênio/sangue , Ativador de Plasminogênio Tecidual/análise , Ativador de Plasminogênio Tecidual/sangue , Ácido Tranexâmico/farmacologia , Ácido Tranexâmico/uso terapêutico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/fisiopatologia
12.
ACS Appl Mater Interfaces ; 12(8): 9132-9140, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32058692

RESUMO

Designing versatile functional medical adhesives with injectability, self-healing, and strong adhesion is of great significance to achieve desirable therapeutic effects for promoting wound sealing in healthcare. Herein, a self-healing injectable adhesive is fabricated by physical interaction of polyphenol compound tannic acid (TA) and eight-arm poly(ethylene glycol) end-capped with succinimide glutarate active ester (PEG-SG). The hydrogen bonding induced from the structural unit (-CH2-CH2-O-) of PEG and catechol hydroxyl (-OH) of TA, accompanied by ester exchange between N-hydroxysuccinimide (-NHS) and amino (-NH2) of proteins, contributes to self-healing ability and rapid strong adhesion. Notably, the PEG/TA adhesive can repeatedly adhere to rigid porcine tissues, close the coronary artery under a large incision tension, and bear a heavy load of 2 kg. By exhibiting shear-thinning and anti-swelling properties, the PEG/TA adhesive can be easily applied through single-syringe extrusion onto various wounds. The single-channel toothpaste-like feature of the adhesive ensures its storage hermetically for portable usage. Moreover, in vivo operation and histological H&E staining results indicate that the PEG/TA adhesive greatly accelerates wound healing and tissue regeneration in a rat model. With the specialty of injectability, instant self-healing, and long-lasting strong adhesion to facilitate excellent therapeutic effects, the multifunctional PEG/TA adhesive may provide a new alternative for self-rescue and surgical situations.


Assuntos
Adesivos Teciduais , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Animais , Feminino , Hidrogéis/química , Hidrogéis/farmacologia , Polietilenoglicóis/química , Polietilenoglicóis/farmacologia , Ratos , Ratos Sprague-Dawley , Succinimidas/química , Succinimidas/farmacologia , Taninos/química , Taninos/farmacologia , Adesivos Teciduais/química , Adesivos Teciduais/farmacologia , Ferimentos e Lesões/metabolismo , Ferimentos e Lesões/patologia
13.
Am J Surg ; 219(3): 400-403, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31910990

RESUMO

BACKGROUND: Geriatric patients, age ≥65, frequently require no operation and only short observation after injury; yet many are prescribed opioids. We reviewed geriatric opioid prescriptions following a statewide outpatient prescribing limit. METHODS: Discharge and 30-day pain prescriptions were collected for geriatric patients managed without operation and with stays less than two midnights from May and June of 2015 through 2018. Patients were compared pre- and post-limit and with a non-geriatric cohort aged 18-64. Fall risk was also assessed. RESULTS: We included 218 geriatric patients, 57 post-limit. Patients received fewer discharge prescriptions and lower doses following the limit. However, this trend preceded the limit. Geriatric patients received fewer opioid prescriptions but higher doses than non-geriatric patients. Fall risk was not associated with reduced prescription frequency or doses. CONCLUSIONS: Opioid prescribing has decreased for geriatric patients with minor injuries. However, surgeons have not reduced dosage based on age or fall risk.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Manejo da Dor , Padrões de Prática Médica/estatística & dados numéricos , Ferimentos e Lesões/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Ohio , Estudos Retrospectivos
14.
J Agric Food Chem ; 68(6): 1621-1633, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-31967468

RESUMO

Collagen peptides can promote wound healing and are closely related to microbiome colonization. We investigated the relationship among collagen peptides, wound healing, and wound microflora colonization by administering the murine wound model with Salmo salar skin collagen peptides (Ss-SCPs) and Tilapia nilotica skin collagen peptides (Tn-SCPs). We analyzed the vascular endothelial growth factor (VEGF), fibroblast growth factors (ß-FGF), pattern recognition receptor (NOD2), antimicrobial peptides (ß-defence14, BD14), proinflammatory (TNF-α, IL-6, and IL-8) and anti-inflammatory (IL-10) cytokines, macrophages, neutrophil infiltration levels, and microbial communities in the rat wound. The healing rates of the Ss-SCP- and Tn-SCP-treated groups were significantly accelerated, associated with decreased TNF-α, IL-6, and IL-8 and upregulated BD14, NOD2, IL-10, VEGF, and ß-FGF. Accelerated healing in the collagen peptide group shows that the wound microflora such as Leuconostoc, Enterococcus, and Bacillus have a positive effect on wound healing (P < 0.01). Other microbiome species such as Stenotrophomonas, Bradyrhizobium, Sphingomonas, and Phyllobacterium had a negative influence and decreased colonization (P < 0.01). Altogether, these studies show that collagen peptide could upregulate wound NOD2 and BD14, which were implicated in microflora colonization regulation in the wound tissue and promoted wound healing by controlling the inflammatory reaction and increasing wound angiogenesis and collagen deposition.


Assuntos
Colágeno/química , Proteínas de Peixes/química , Microbiota/efeitos dos fármacos , Proteína Adaptadora de Sinalização NOD2/genética , Peptídeos/administração & dosagem , Pele/química , Ferimentos e Lesões/fisiopatologia , beta-Defensinas/genética , Administração Cutânea , Animais , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Ciclídeos , Fatores de Crescimento de Fibroblastos/genética , Fatores de Crescimento de Fibroblastos/imunologia , Humanos , Interleucina-10/genética , Interleucina-10/imunologia , Masculino , Camundongos , Proteína Adaptadora de Sinalização NOD2/imunologia , Peptídeos/química , Ratos , Ratos Sprague-Dawley , Salmo salar , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/imunologia , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/imunologia , Ferimentos e Lesões/microbiologia , beta-Defensinas/imunologia
15.
s.l; RedARETS; ene. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1095210

RESUMO

INTRODUCCIÓN: Se puede formar tejido cicatricial después de una cirugía, trauma o diversas afecciones inflamatorias. Las cicatrices pueden crear muchas funciones adversas, efectos cosméticos y estructurales, y a veces efectos psicológicos, eso puede afectar la vida diaria de los pacientes (Kerwin et al., 2014). El mecanismo de reparación de cicatrices a nivel molecular no es bien comprendido (Gladstone et al., 2010). BÚSQUEDA: Ensayos randomizados controlados o ensayos no randomizados, meta-análisis y evaluaciones de tecnologías que evalúen el uso de toxina botulínica en el tratamiento de las heridas y/o cicatrices cutáneas. MÉTODOS: De las 3 revisiones sistemáticas con metaanálisis encontradas se seleccionaron dos con alto nivel de confianza de acuerdo con la herramienta AMSTAR-2 que evaluaron Toxina botulínica A frente a placebo. Se evaluó el sesgo de los estudios incluidos y se realizaron perfiles de evidencia utilizando la metodología GRADE con el programa GRADE-PRO GDT teniendo en cuenta los desenlaces seleccionados como criticos o importantes. RESULTADOS: a. Evaluado en postquirúrgico de cirugía reciente, sobre piel previamente sana. b. Heterogeneidad entre estudios I2 27% y p 0,10. c. Evaluado en cocatriz hipertrófica o queloide.


Assuntos
Humanos , Ferimentos e Lesões/tratamento farmacológico , Queimaduras/tratamento farmacológico , Toxinas Botulínicas Tipo A/uso terapêutico , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
16.
J Wound Care ; 29(1): 44-50, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31930945

RESUMO

OBJECTIVE: This study aims to compare the efficacy of enoxaparin, rivoraxaban and dabigatran on wound healing using a rat model. METHOD: Sprague-Dawley female rats (n=56), 10-12 weeks old, weight 245±30g, were used in this study. The rats were divided into four equally-sized groups. A type 1 (secondary wound healing) and type 2 (primary wound healing) wound was opened surgically on each rat in each group. Anticoagulent drugs enoxaparin, rivoraxaban and dabigatran and physiological saline solution were administered to Groups 1, 2, 3 and 4, respectively. After wound healing was scored tissue samples were taken from euthanised rats at days five and 10 and examined histologically. Since time was used as a classification (days five and 10), a time effect was included. RESULTS: There was no statistically significant difference in total score distribution in rats between type 1 secondary wounds for days five and 10 (p>0.05). There was no statistically significant difference in the overall score distribution in rats between type 2 primary wounds for days five and 10 (p>0.05). CONCLUSION: In addition to the use of low molecular weight heparin with well-known anticoagulation activity, the new generation oral medications are used efficiently in thromboembolic diseases. However, there was no evidence observed in this study that these drugs could be either beneficial or harmful to wound healing.


Assuntos
Anticoagulantes/farmacologia , Pele/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Administração Cutânea , Administração Oral , Animais , Anticoagulantes/administração & dosagem , Dabigatrana/administração & dosagem , Dabigatrana/farmacologia , Enoxaparina/administração & dosagem , Enoxaparina/farmacologia , Feminino , Modelos Animais , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Rivaroxabana/administração & dosagem , Rivaroxabana/farmacologia , Solução Salina/administração & dosagem , Solução Salina/farmacologia , Método Simples-Cego , Pele/patologia , Resultado do Tratamento , Ferimentos e Lesões/patologia
17.
J Wound Ostomy Continence Nurs ; 47(1): 20-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929440

RESUMO

PURPOSE: This project examined knowledge, attitudes, beliefs, and behaviors about systemic antibiotic use for persons who reported a wound within the previous year. DESIGN: Secondary data analyses of 505 adults from a cross-sectional, prospective, intercept survey where every fifth adult was randomly approached to participate. SUBJECTS AND SETTING: Twenty-six participants (5.15% of the parent sample) stated having a wound within the previous year. METHODS: Participants were "interviewed" using the Facilitators and Barriers to Consumer Use of Antibiotics questionnaire that included demographics, health, information sources, antibiotic knowledge, attitudes, beliefs, and behavior questions. Hierarchical agglomerative cluster analysis was used to find clusters of items on the attitude, beliefs, and behavior questions. RESULTS: Sample demographics included 15 women and 11 African Americans, and 17 had some college education. Knowledge about antibiotics had a mean correct score of 10 out of 15 (67%) questions. Higher antibiotic knowledge was significantly related to higher education (rs = 0.69, P < .001). There were 2 attitude and beliefs clusters: most participants (>85%) recognized the need for medical supervision of antibiotic use (cluster 1), and beliefs about the need for antibiotics to prevent illness or treat wounds varied in 27% to 62% of participants (cluster 2). There were 4 behavior clusters: almost all participants 96% (cluster 1) filled and took the antibiotic if prescribed; greater than 71% (cluster 2) disagreed with unapproved methods of obtaining antibiotics; greater than 87% (cluster 3) used prescribed antibiotics correctly; and 36% of participants heard about antibiotic resistance through television or radio or Internet (40%) (cluster 4). CONCLUSIONS: Knowledge about antibiotics was low, while attitudes were positive. These findings support the need for research and evidence-based information on the role of antibiotics in wound care.


Assuntos
Antibacterianos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Ferimentos e Lesões/tratamento farmacológico , Adulto , Gestão de Antimicrobianos/normas , Gestão de Antimicrobianos/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Ferimentos e Lesões/psicologia
19.
Yonsei Med J ; 61(1): 79-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887803

RESUMO

PURPOSE: Hyaluronidase (HAase) has many uses in medicine, and reports suggest that it affects perineal tissue during fetal passage through the vaginal canal. However, its potential use for preventing perineal trauma has yet to be determined. This study sought to evaluate the efficacy and safety of perineal HAase injections in reducing perineal trauma during vaginal delivery. MATERIALS AND METHODS: A multi-center, double-blind, placebo-controlled, randomized study was conducted from January 2016 to March 2017. Nulliparous women who planned to undergo vaginal delivery were recruited, and the enrolled women were randomly assigned to the HAase injection group (HAase injection, 5000 IU, n=75) or the control group (normal saline injection, n=73). The degree of perineal laceration, rate of episiotomy, and grade of perineal edema at 1 hour and 24 hours after spontaneous vaginal delivery were compared between the two groups. RESULTS: A total of 148 women who underwent vaginal delivery were recruited. No significant differences were observed between the HAase injection and control groups in the rates of perineal laceration (p=0.422). Perineal edema significantly decreased 24 hours after delivery in the women treated with perineal HAase injections, compared to women in the control group (p=0.008). The overall incidences of adverse events, such as redness of the injection site, infection, and wound dehiscence, were similar between the two groups. CONCLUSION: HAase injections in nulliparous women afforded no reductions in the rates of perineal lacerations and episiotomy. However, the use of perineal HAase injections did reduce perineal edema without severe adverse events.


Assuntos
Hialuronoglucosaminidase/uso terapêutico , Períneo/patologia , Ferimentos e Lesões/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Parto Obstétrico , Método Duplo-Cego , Edema/patologia , Episiotomia , Feminino , Humanos , Hialuronoglucosaminidase/administração & dosagem , Incidência , Recém-Nascido , Lacerações/etiologia , Placebos , Gravidez , Resultado do Tratamento , Adulto Jovem
20.
PLoS One ; 14(12): e0226433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841556

RESUMO

OBJECTIVE: To describe temporal trends and factors associated with opioid administration among children discharged from the emergency department (ED) after a trauma visit. METHODS: This was a cross-sectional study of ED visits for children <19 years old who received a trauma-related diagnosis and were discharged from the ED. Data were obtained from the National Hospital Ambulatory Medical Care Survey 2006-2015. OUTCOME MEASURES: Administration of an opioid medication either during the ED visit or as a discharge prescription. Survey-adjusted regression analyses were used to determine the probability of a patient receiving an opioid medication. RESULTS: During the study period, there were 19,241 pediatric trauma visits discharged from the ED, of which 14% were associated with an opioid. Opioid administration decreased by nearly 30% during the study period (p<0.001 for trend). In multivariable analysis, patient factors associated with opioid administration were adolescent age, evening visit, region of the country, and severe pain score. The diagnosis associated with the most opioids was ankle sprain and the diagnosis with the highest rate of opioid administration was radius fracture. The most common opioid administered to children under 12 years of age was acetaminophen-codeine. CONCLUSIONS: Opioid administration appears to be decreasing among pediatric patients presenting to the ED with trauma, but a high number of children continue to be exposed to opioids every year. Further education on opioid sparing pain management strategies may be warranted to decrease opioid exposure, including the inappropriate use of codeine, in this low risk trauma population.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor/tratamento farmacológico , Dor/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Emergências , Serviço Hospitalar de Emergência , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Manejo da Dor/estatística & dados numéricos , Manejo da Dor/tendências , Gravidade do Paciente , Alta do Paciente/estatística & dados numéricos , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia , Ferimentos e Lesões/complicações
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