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1.
Medicina (B Aires) ; 79(3): 167-173, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284250

RESUMO

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Pé Diabético/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Pé Diabético/microbiologia , Quimioterapia Combinada , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia
2.
J Forensic Leg Med ; 67: 15-18, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352159

RESUMO

Torture, which violates human rights, is still being practiced worldwide despite of all the bound rules and regulations. Although "beating" is the commonest method applied, other physical, psychological and sexual methods are often being practiced. 1975 Tokyo declaration defines torture and the doctor's role in managing torture. Injury identification and accurate dating are major challenges faced by medical professionals in dealing with cases of torture. Inadequacy of the history and late presentation are another major issues that often interfere with proper medico-legal management. It would be wise for the professional who is involved in management of torture cases to be thorough of 'Istanbul protocol' which contain the first set of internationally recognized standards for effective examination of torture victim. This case report discusses some of the entities such as beating, water torture, mock execution and other psychological methods, and rear occurrence of hanging with near death experience.


Assuntos
Traumatismo Múltiplo/patologia , Tortura , Privação de Alimentos , Humanos , Masculino , Exame Físico , Polícia , Sri Lanka , Infecção dos Ferimentos/patologia
3.
Zhonghua Shao Shang Za Zhi ; 35(5): 379-383, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154737

RESUMO

Objective: To investigate the current status of uncertainty in illness and caregiving burden in family members of patients with chronic wounds, and to analyze the relationship between them. Methods: A total of 180 patients with chronic wounds admitted to the Department of Emergency of our hospital from October 2017 to March 2018, conforming to the study criteria, were selected by adopting the convenience sampling method. Then one family member who took care of the patients for the longest time and conformed to the study criteria were included in this cross-sectional survey. General Information Questionnaire made by the authors was conducted to investigate the demographic data and wounds of patients, and demographic data of family members. Chinese version of Parent Perception of Uncertainty Scale-Family Member (PPUS-FM) and Caregiver Burden Inventory (CBI) were used to investigate the uncertainty in illness and caregiving burden. Data were processed with multiple linear regression analysis and partial correlation analysis. Results: The effective recovery rate of questionnaire was 91.7% (165/180). (1) The ages of patients were (71±17) years. Among them, there were 89 males and 76 females. The course of chronic wounds was 0.5 to 120.0 months. The wounds were mainly primary occurrence (86.1%, 142 patients), and the main type of wound was pressure ulcer (43.6%, 72 patients). Fifty-seven patients (34.5%) had wound infection. The ages of family members were (56±13) years, and 61.8% (102 people) of them were female. Their daily time of taking care of patients was (10±8) h. (2) The total scores of PPUS-FM of family members were 33 to 125 (88±17) points, mainly in medium level, in which the item score of unpredictability dimension was the highest. (3) The total scores of CBI of family members were 7 to 79 (43±14) points, in which the item score of time-dependence burden dimension was the highest. (4) Uncertainty in PPUS-FM could independently influence 10% of the total variation of caregiving burden in family members of patients (t=3.18, P<0.01). (5) The total scores of PPUS-FM of family members were in significantly positive correlation with the total scores of CBI and scores of physical burden, emotional burden, and social burden, respectively (r=0.33, 0.32, 0.25, 0.36, P<0.05 or P<0.01), while there was no obvious correlation between total scores of PPUS-FM of family members and time-dependence burden/developmental burden (r=0.14, 0.16, P>0.05). Conclusion: There is positive correlation between uncertainty in illness and caregiving burden.


Assuntos
Adaptação Psicológica , Queimaduras/complicações , Cuidadores/psicologia , Incerteza , Infecção dos Ferimentos/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
BMC Surg ; 19(1): 65, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215452

RESUMO

BACKGROUND: Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. METHODS: Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. RESULTS: The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. CONCLUSIONS: Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.


Assuntos
Tratamento de Ferimentos com Pressão Negativa/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos , Cicatrização , Adulto , Canal Anal/lesões , Drenagem/métodos , Feminino , Humanos , Ileostomia/métodos , Masculino , Pessoa de Meia-Idade , Períneo/lesões , Estudos Retrospectivos , Sacro/lesões , Pele/patologia , Infecção dos Ferimentos/epidemiologia
6.
Angiol Sosud Khir ; 25(2): 11-15, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31149986

RESUMO

The purpose of the study was to comparatively assess efficacy of using agents belonging to the group of prostaglandin E1 in comprehensive conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes by the frequency of major amputation, amputation-free survival, and total mortality by combinations of the WIfI classification during a 6-month follow up period. Our retrospective multicentre study enrolled a total of 109 patients, including 60 men and 49 women, with a mean age of 70±7.3 years. The patients were subdivided into 2 groups. Group 1 patients (n=58) received standard conservative therapy without prostaglandin E1 and group 2 patients (n=51) received similar treatment with the use of prostaglandin E1. The statistical analysis (chi-squared test, Fisher criterion, log-rank test) was carried out with regard to stratification of the patients in the groups by the WIfI component combinations. No statistically significant differences between the groups in the frequency of amputation and total mortality were revealed (p=0.094 and p=0.925, respectively). The use of the WIfI classification system made it possible to single out a cohort of patients (with a WIfI combination of 130) for whom the results of administering prostaglandin E1 statistically significantly differed by the frequency of amputation (p=0.042) and by amputation-free survival (p=0.017). No significant differences by these outcomes were obtained for other combinations analysed. A conclusion was drawn that using prostaglandin E1 in comprehensive conservative treatment decreased the frequency of amputation and increased amputation-free survival in patients presenting with unreconstructable critical limb ischaemia and referred to the category with a combination of 130 according to the WIfI classification.


Assuntos
Tratamento Conservador , Isquemia , Salvamento de Membro , Infecção dos Ferimentos , Idoso , Amputação , Técnicas de Apoio para a Decisão , Feminino , Humanos , Isquemia/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização
7.
BMC Surg ; 19(1): 54, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138196

RESUMO

BACKGROUND: Appendicitis in elderly patients is associated with increased risk of postoperative complications. The choice between laparoscopy and open appendectomy remains controversial in treating elderly patients with appendicitis. METHODS: Comprehensive search of literature of MEDLINE, Embase, Cochrane Library and ClinicalTrials was done in January 2019. Studies compared laparoscopy and open appendectomy for elderly patients with appendicitis were screened and selected. Postoperative mortality, complications, wound infection, intra-abdominal abscess and operating time, length of hospital stay were extracted and analyzed. The Review Manage 5.3 was used for data analysis. RESULTS: Twelve studies with 126,237 patients in laparoscopy group and 213,201 patients in open group. Postoperative mortality was significantly lower following laparoscopy (OR, 0.33; 95% CI, 0.28 to 0.39). Postoperative complication and wound infection were reduced following laparoscopy ((OR, 0.65 95% CI, 0.62 to 0.67; OR,0.27, 95% CI, 0.22 to 0.32). Intra-abdominal abscess was similar between LA and OA (OR,0.44;95% CI, 0.19 to 1.03). Duration of surgery was longer following laparoscopy and length of hospital stay was shorter following laparoscopy (MD, 7.25, 95% CI, 3.13 to 11.36; MD,-2.72, 95% CI,-3.31 to - 2.13). CONCLUSIONS: Not only laparoscopy is safe and feasible, but also it is related with decreased rates of mortality, post-operative morbidity and shorter hospitalization.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/cirurgia , Idoso , Apendicectomia/efeitos adversos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Infecção dos Ferimentos/epidemiologia
8.
Stud Health Technol Inform ; 260: 192-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118337

RESUMO

The steady increase in the number of patients equipped with mechanical heart support implants, such as left ventricular assist devices (LVAD), along with virtually ubiquitous 24/7 internet connectivity coverage is motive to investigate and develop remote patient monitoring. In this study we explore machine learning approaches to infection severity recognition on driveline exit site images. We apply a U-net convolutional neural network (CNN) for driveline tube segmentation, resulting in a Dice score coefficient of 0.95. A classification CNN is trained to predict the membership of one out of three infection classes in photographs. The resulting accuracy of 67% in total is close to the measured expert level performance, which indicates that also for human experts there may not be enough information present in the photographs for accurate assessment. We suggest the inclusion of thermographic image data in order to better resolve mild and severe infections.


Assuntos
Aprendizado Profundo , Coração Auxiliar , Redes Neurais (Computação) , Infecções Relacionadas à Prótese , Infecção dos Ferimentos , Coração Auxiliar/efeitos adversos , Humanos , Infecção dos Ferimentos/diagnóstico
9.
Appl Microbiol Biotechnol ; 103(12): 4767-4778, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31065753

RESUMO

Natural rubber latex (NRL) is a natural polymer which has arisen large interest in the biomedical field, mostly, due to its ability to facilitate angiogenesis and therefore, tissue repair. Moxifloxacin (MXF) is a broad-spectrum antibiotic orally administrated. Considering the biological properties of the NRL and its ability to deliver a wide range of compounds, the present study aimed to develop a novel device for infected chronic wound treatment. MXF-loaded NRL was obtained by a casting method. The results demonstrated that the incorporation of MXF in NRL did not promote any molecular interaction, preserving the integrity of the compounds. The mechanical properties of the biomaterial did not show any significant change, indicating enough elasticity for dermal application. The microbiological assays confirmed the ability of the polymer to deliver the drug without influencing its pharmacological properties. Moreover, it has expressed activity against major bacterial strains presented in wound infections. Finally, the biomaterial shown biocompatibility from the in vitro study. Thus, the present work has shown that MXF-loaded NRL membrane is a promising biomaterial to infected wound treatment.


Assuntos
Bandagens , Sistemas de Liberação de Medicamentos/instrumentação , Moxifloxacina/farmacologia , Polímeros/química , Infecção dos Ferimentos/terapia , Animais , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Linhagem Celular , Escherichia coli/efeitos dos fármacos , Fibroblastos/microbiologia , Humanos , Queratinócitos/microbiologia , Látex/química , Camundongos , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/efeitos dos fármacos , Borracha/química , Cicatrização
10.
AAPS PharmSciTech ; 20(5): 169, 2019 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-31004249

RESUMO

The aim of the present study was to explore the therapeutic efficacy of microemulsion-based delivery of histidine-capped silver nanoparticles in eradicating Klebsiella pneumoniae-induced burn wound infection. The developed microemulsion was characterized on the basis of differential light scattering, phase separation, refractive index, and specific conductance. Emulgel was prepared and characterized on the basis of thixotropy, texture, differential scanning calorimetry, and release kinetics. Emulgel was further evaluated in skin irritation and in vivo studies, namely full-thickness K. pneumoniae-induced burn wound infection treatment via topical route. Efficacy of treatment was evaluated in terms of bacterial load, histopathology, wound contraction, and other infection markers. The developed emulgel provided significant in vivo antibacterial activity of histidine-capped silver nanoparticle preparations via topical route and resulted in reduction in bacterial load, wound contraction, and enhanced skin healing as well as decrement of inflammatory markers such as malondialdehyde, myeloperoxidase, and reactive nitrogen intermediate compared to untreated animals. The present study encourages the further employment of histidine-capped silver nanoparticles along with microemulsion-based drug delivery system in combating antibiotic-resistant topical infections.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/uso terapêutico , Queimaduras/complicações , Histidina/administração & dosagem , Histidina/uso terapêutico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Compostos de Prata/administração & dosagem , Compostos de Prata/uso terapêutico , Infecção dos Ferimentos/tratamento farmacológico , Administração Tópica , Animais , Sistemas de Liberação de Medicamentos , Emulsões , Feminino , Géis , Infecções por Klebsiella/microbiologia , Nanopartículas Metálicas , Camundongos , Camundongos Endogâmicos BALB C , Nanopartículas/administração & dosagem , Nanopartículas/uso terapêutico , Infecção dos Ferimentos/microbiologia
11.
BMC Surg ; 19(1): 41, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023289

RESUMO

BACKGROUND: Recently, laparoscopic appendectomies (LAs) have been widely performed instead of open appendectomies (OAs) during pregnancy. However, concerns about the safety of LA during pregnancy remain. This systematic review and meta-analysis aimed to evaluate the current evidence relating to the safety of LA versus OA for suspected appendicitis during pregnancy. METHODS: Comprehensive literature searches were conducted using the PubMed, EMBASE, and Cochrane Library databases to identify articles describing LA versus OA in pregnancy, without restrictions regarding the publication date. The primary endpoints were fetal loss and preterm delivery. RESULTS: After screening 801 studies, 22 comparative cohort studies were included in the analysis, which involved 4694 women, of whom 905 underwent LAs and 3789 underwent OAs. Fetal loss was significantly higher among those who underwent LAs compared with those who underwent OAs, and the pooled odds ratio (OR) was 1.72 (95% confidence interval [CI]: 1.22-2.42) without heterogeneity. The sensitivity analysis showed that the effect size was influenced by one of the studies, because its removal resulted in there being no significant difference between LA and OA with respect to the risk of fetal loss (OR 1.163, 95% CI: 0.68-1.99; P = 0.581). A significant difference was not evident between LA and OA with respect to preterm delivery (OR 0.76, 95% CI: 0.51-1.15), a result that did not change following the sensitivity analysis. The patients who underwent LA had shorter hospital stays (mean difference - 1.01, 95% CI: -1.61--0.41) and a lower wound infection risk (OR 0.40, 95% CI: 0.21-0.76) compared with those who underwent OA. CONCLUSION: It is not reasonable to conclude that LA in pregnant women might be associated with a greater risk of fetal loss. The difference between LA and OA with respect to preterm delivery was not significant.


Assuntos
Apendicectomia/efeitos adversos , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações na Gravidez/cirurgia , Bases de Dados Factuais , Feminino , Morte Fetal , Humanos , Tempo de Internação , Razão de Chances , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Infecção dos Ferimentos
12.
ACS Appl Mater Interfaces ; 11(16): 14597-14607, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-30938506

RESUMO

Along with the rapid appearance of superbacteria with multidrug resistance, it is a challenge to develop new antibacterial materials to address this big issue. Herein, we report a novel amine group-modified fullerene derivative (C70-(ethylenediamine)8 abrr. C70-(EDA)8), which reveals a high performance in killing superbacteria, and most importantly, it shows negligible toxicity to the mammalian cells. The strong antibacterial ability of this material was attributed to its unique molecular structure. On one hand, amino groups on the EDA part make it easy to affix onto the outer membrane of multidrug resistance Escherichia coli by electrostatic interactions. On the other hand, the hydrophobic surface on the C70 part makes it easy to form a strong hydrophobic interaction with the inner membrane of bacteria. Finally, C70-(EDA)8 leads to the cytoplast leakage of superbacteria. In contrast, the C70-(EDA)8 is nontoxic for mammalian cells due to different distributions of the negative charges in the cell membrane. In vivo studies indicated that C70-(EDA)8 mitigated bacterial infection and accelerated wound healing by regulating the immune response and secretion of growth factors. Our amine group-based fullerene derivatives are promising for clinical treatment of wound infection and offer a new way to fight against the superbacteria.


Assuntos
Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Escherichia coli , Escherichia coli/crescimento & desenvolvimento , Fulerenos , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos , Animais , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/metabolismo , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Fulerenos/química , Fulerenos/farmacocinética , Fulerenos/farmacologia , Células HEK293 , Humanos , Masculino , Ratos , Ratos Wistar , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/metabolismo , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/patologia
13.
Mater Sci Eng C Mater Biol Appl ; 100: 915-927, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30948128

RESUMO

The nepenthes-inspired slippery liquid-infused surface has led to multiple potentials in biomedical devices' design. This study aims to develop a biomimetic, environmentally-friendly slippery layer of oil-infused 3D printed polydimethylsiloxane with anti-bacterial nanosilver (iPDMS/AgNPs) for wound dressing. The engineered 3D printed iPDMS can cater the different requirements of wounds with antifouling, anti-blood staining, and kill bacteria. iPDMS/AgNPs not only exhibits biocompatibility, against adherence and effective antibacterial activity but also effectively promotes neo-epithelial and granulation tissue formation to accelerate wound healing in vivo. Optimized rheologic parameters were obtained for the 3D printable iPDMS pre-polymerization condition. Scanning electronic micrograph (SEM) and Energy Dispersive Spectrometer (EDS) show a uniform mesh with AgNPs dotted on the printed dressing. No cytotoxicity of iPDMS/AgNPs has been found via cell Counting Kit-8(CCK-8) assay. Meanwhile, the membranes infused with silicon oil effectively prevented from the adherence of the two standard drug-resistant bacteria, Staphylococcus aureus and Escherichia coli (PDMS vs. PDMS+oil, p < 0.05; PDMS+0.5%AgNPs vs. iPDMS+0.5%AgNPs, p < 0.05; PDMS+2.5%AgNPs vs. iPDMS+2.5%AgNPs, p < 0.05). By bacteria co-culture model iPDMS/AgNPs can kill about 80% of Staphylococcus aureus and Escherichia coli. When applied to a full-thickness wound defect model of murine, iPDMS/AgNPs was effective in anti-infection. It also promotes the epithelialization, the granulation tissue formation, and wound healing. These findings demonstrate that iPDMS/AgNPs may have therapeutic promise as an ideal wound dressing shortly.


Assuntos
Antibacterianos/uso terapêutico , Incrustação Biológica , Biomimética , Dimetilpolisiloxanos/farmacologia , Óleos/química , Impressão Tridimensional , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos/tratamento farmacológico , Animais , Antibacterianos/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Modelos Animais de Doenças , Escherichia coli/efeitos dos fármacos , Fibroblastos/citologia , Fibroblastos/efeitos dos fármacos , Tecido de Granulação/efeitos dos fármacos , Tecido de Granulação/patologia , Íons , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Nanocompostos/química , Nanocompostos/ultraestrutura , Reologia , Prata/química , Espectroscopia de Infravermelho com Transformada de Fourier , Staphylococcus aureus/efeitos dos fármacos , Temperatura Ambiente , Infecção dos Ferimentos/patologia
14.
Angiol Sosud Khir ; 25(1): 9-16, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30994602

RESUMO

In the present article, the authors substantiate the necessity of subdividing a heterogeneous cohort of patients presenting with Fontaine-Pokrovsky grade IV critical limb ischaemia into subgroups with the aim of making an appropriate therapeutic decision and predicting the outcome. We also translated into the Russian language the WIfI classification system developed by the Society for Vascular Surgery (2014) in order to predict limb loss and feasibility of performing revascularization. This is followed by comments on the classification, accompanied by examples of own clinical case studies. In order to check-up the ability of the SVS WIfI classification system to predict the one-year risk of major amputation in patients with decompensated ischaemia, we carried out a retrospective multicenter study, enrolling a total of 109 patients with unreconstructable stage IV chronic ischaemia. Our primary endpoint was the frequency of major amputation during the first year of follow up. The patients were divided into 4 subgroups based on a combination of the three WIfI domains, i. e., wound, ischaemia, and foot infection, respectively, as follows: 130 - 27% (n=29), 131 - 23% (n=25), 230 - 20% (n=22), and 231 - 30% (n=33). The frequency of amputation during the first year of follow-up with the natural course of the disease on the background of conventional therapy averagely amounted to 36%. By the WIfI component combinations, we revealed statistically significant differences between the subgroups (p=0.035): 130 - 21% (n=6), 131 - 28% (n=7), 230 - 36% (n=8), 231 - 55% (n=18). The WIfI classification makes it possible to predict the risk of major amputation in patients with limb-threatening ischaemia. The frequency of amputation during the first year of follow up in the natural course of the disease is associated not only with the WIfI clinical stage but also with the WIfI component combinations.


Assuntos
Salvamento de Membro , Infecção dos Ferimentos , Amputação , Técnicas de Apoio para a Decisão , Humanos , Isquemia , Estimativa de Kaplan-Meier , Extremidade Inferior , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização
15.
J Laparoendosc Adv Surg Tech A ; 29(5): 703-709, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30945979

RESUMO

Background: This study aimed to evaluate single-port laparoscopic appendectomy (SPLA) in comparison with three-port laparoscopic appendectomy (3PLA) in children about the extent of surgical trauma after SPLA and 3PLA measured by serum interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations. Materials and Methods: A total of 50 patients with a median age of 11.5 were randomized to two groups. Experts in both methods performed the surgeries. The decision on the type of planned surgery was randomly determined. Serum IL-6 and CRP levels were measured using an enzyme-linked immunosorbent assay before, and at 12 and 36 hours after surgery. Furthermore, we compared operating time, hospital stay, postoperative pain, and complication rates. Results: The operative time in the 3PLA group was shorter than that in the SPLA group (P < .05). Preoperative IL-6 levels were not different between the two groups, but the rise (pre- versus postoperative) of IL-6 in the SPLA group was remarkably higher when compared with the 3PLA group (P < .05). Similar results were obtained for CRP; basal serum CRP levels were not different between the two groups, but the rise of CRP in the 3PLA group was significantly lower compared with that in the SPLA group. During the first 12 hours postoperative, the SPLA patients reported more severe postoperative pain and longer inpatient opiate usage was noted that after 3-PLA. Only one SPLA case was converted to 3PLA. There were no conversions to open surgery. The length of hospital stay and complication rate were not different between the two groups. Conclusions: SPLA in children is associated with longer operative times, increased pain level, and more severe surgical trauma as measured by postoperative CRP and IL-6 levels in comparison with a 3PLA. The two approaches were comparable regarding the length of hospital stay and complication rate.


Assuntos
Apendicectomia/instrumentação , Apendicite/cirurgia , Laparoscopia/instrumentação , Dor Pós-Operatória/etiologia , Adolescente , Analgésicos Opioides , Apendicectomia/métodos , Proteína C-Reativa/análise , Criança , Conversão para Cirurgia Aberta/efeitos adversos , Feminino , Humanos , Interleucina-6/sangue , Complicações Intraoperatórias/cirurgia , Laparoscopia/métodos , Tempo de Internação , Masculino , Duração da Cirurgia , Período Pós-Operatório , Estudos Prospectivos , Ferida Cirúrgica/complicações , Fatores de Tempo , Infecção dos Ferimentos/prevenção & controle
16.
Artigo em Inglês | MEDLINE | ID: mdl-30992125

RESUMO

During the past decade, there has been an increase in the awareness of infections associated with pregnancy and delivery. The most significant cause of post-partum infection is caesarean section; 20-25% of operations are followed by wound infections, endometritis or urinary tract infections. Approximately 13% of women in the UK undergo operative vaginal delivery (OVD) with forceps or vacuum, which is also associated with an increased risk of infection, estimated at 0.7%-16% of these deliveries. Despite this, previous reviews have identified only one small trial of antibiotic prophylaxis in 393 women and concluded that there was insufficient evidence to support the routine use of prophylactic antibiotics after OVD. The ANODE trial, a multicentre, blinded, placebo-controlled trial from the UK, is due to report findings from more than 3400 women in 2019 and will be the largest study to date of antibiotic prophylaxis following OVD.


Assuntos
Endometrite/etiologia , Extração Obstétrica/efeitos adversos , Transtornos Puerperais/etiologia , Infecções Urinárias/etiologia , Infecção dos Ferimentos/etiologia , Antibioticoprofilaxia , Endometrite/prevenção & controle , Feminino , Humanos , Períneo/lesões , Gravidez , Transtornos Puerperais/prevenção & controle , Fatores de Risco , Sepse/diagnóstico , Sepse/etiologia , Sepse/prevenção & controle , Infecções Urinárias/prevenção & controle , Infecção dos Ferimentos/prevenção & controle
17.
Wounds ; 31(3): E14-E17, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30924795

RESUMO

OBJECTIVE: The aim of this study was to gain a greater understanding of the perceptions of wound biofilm held by wound care clinicians. METHODS: Independent market research was conducted in the United States and Europe via an online questionnaire to understand the knowledge levels of wound biofilm among clinicians. RESULTS: Clinicians from the United States appeared most knowledgeable on the subject of wound biofilm, though there was a wider consensus that biofilm contributes to delayed wound healing. A number of visual and indirect clinical signs for the presence of wound biofilm were commonly listed by all clinicians. In this study, and others, widespread calls for further education on wound biofilm, in addition to anti-biofilm and diagnostic technologies, were made. CONCLUSIONS: This study has contributed to the global call to focus on tackling biofilm for the benefit of wound care patients, caregivers, and health care systems.


Assuntos
Biofilmes , Marketing , Médicos , Cicatrização/fisiologia , Infecção dos Ferimentos/microbiologia , Anti-Infecciosos/uso terapêutico , Atitude do Pessoal de Saúde , Biofilmes/efeitos dos fármacos , Europa (Continente) , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Percepção , Estados Unidos , Infecção dos Ferimentos/diagnóstico
18.
PLoS Pathog ; 15(3): e1007511, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30893371

RESUMO

While much is known about acute infection pathogenesis, the understanding of chronic infections has lagged. Here we sought to identify the genes and functions that mediate fitness of the pathogen Pseudomonas aeruginosa in chronic wound infections, and to better understand the selective environment in wounds. We found that clinical isolates from chronic human wounds were frequently defective in virulence functions and biofilm formation, and that many virulence and biofilm formation genes were not required for bacterial fitness in experimental mouse wounds. In contrast, genes involved in anaerobic growth, some metabolic and energy pathways, and membrane integrity were critical. Consistent with these findings, the fitness characteristics of some wound impaired-mutants could be represented by anaerobic, oxidative, and membrane-stress conditions ex vivo, and more comprehensively by high-density bacterial growth conditions, in the absence of a host. These data shed light on the bacterial functions needed in chronic wound infections, the nature of stresses applied to bacteria at chronic infection sites, and suggest therapeutic targets that might compromise wound infection pathogenesis.


Assuntos
Proliferação de Células/fisiologia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Cicatrização/fisiologia , Adulto , Animais , Bactérias/crescimento & desenvolvimento , Infecções Bacterianas/metabolismo , Biofilmes/crescimento & desenvolvimento , Modelos Animais de Doenças , Feminino , Aptidão Genética , Interações entre Hospedeiro e Microrganismos/fisiologia , Humanos , Masculino , Camundongos , Infecções por Pseudomonas , Pseudomonas aeruginosa/metabolismo , Pseudomonas aeruginosa/patogenicidade , Virulência/fisiologia , Infecção dos Ferimentos/metabolismo , Infecção dos Ferimentos/microbiologia
19.
Medicine (Baltimore) ; 98(12): e14892, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30896636

RESUMO

Diabetic foot infection (DFI) should be treated by a multidisciplinary team to prevent amputation and morbid status. As physicians encountering DFI in outpatient clinic, a proper selection of antibiotic treatment and diagnostic approach for a vascular status is essential. We retrospectively investigated the patients with DFI from 2016 to 2017. All patients were examined for vascular status, wound status, and pathologic culture preceding the treatment. No statistical significance was observed between PEDIS grade 1 and 2 and 3 and 4 in culture status and culture results. Association analysis between vascular status and other variables, such as wound score and culture results, has no significant difference. Through these results, the helpful epidemiologic result of microbiology and necessity of examination for peripheral arterial disease were verified.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/complicações , Pé/irrigação sanguínea , Infecção dos Ferimentos/complicações , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Idoso , Pé Diabético/terapia , Feminino , Humanos , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Infecção dos Ferimentos/terapia
20.
Artif Cells Nanomed Biotechnol ; 47(1): 980-988, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30857435

RESUMO

The pathogenic bacteria delay wound healing due to their interaction in the wound area. This study is aimed to evaluate the efficiency of topical rosemary essential oil (REO) loaded into the nanostructured lipid carriers (NLCs) on in vitro antibacterial activity and in vivo infected wound healing process in the animal model. REO-NLCs morphology, size and in vitro antibacterial activity were done. Two circular full-thickness wound (each 6 mm) were made on the back of each mouse and each wound was infected with a solution containing 107 CFU Staphylococcus aureus and Pseudomonas aeruginosa. Animals were divided into four groups including control, Mupirocin® and two treated groups with a gel containing REO and REO-NLCs. For this purpose, tissue bacterial count, histological assessment, serum level of IL-3, IL-10, VEGF and SDF-1α were evaluated. REO-NLCs showed antibacterial activity against Staphylococcus epidermidis, Staphylococcus aureus, Listeria monocytogenes, Escherichia coli and Pseudomonas aeruginosa. Moreover, REO-NLCs could reduce the rate of tissue bacterial colonization and wound size, while they increased the vascularization, fibroblast infiltration, re-epithelialization, collagen production, IL-3, IL-10, VEGF and SDF-1α serum levels. Our finding revealed the REO-NLCs have antibacterial properties and accelerated infected wound healing, and so that confirming their potential clinical uses for the treatment of infected wounds.


Assuntos
Antibacterianos/administração & dosagem , Portadores de Fármacos/química , Lipídeos/química , Nanoestruturas/administração & dosagem , Óleos Voláteis/química , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos/tratamento farmacológico , Administração Tópica , Animais , Antibacterianos/química , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Carga Bacteriana , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos , Mediadores da Inflamação/metabolismo , Camundongos , Testes de Sensibilidade Microbiana , Nanoestruturas/química , Óleos Voláteis/administração & dosagem , Resultado do Tratamento , Cicatrização/fisiologia , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/patologia
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