Factors influencing dressing choice in wound care: a discussion.

Dressing choice can be challenging for clinicians, with many different product types and makes now available. The cost of wound care products is 93% higher for unhealed wounds than for those that heal, so planning appropriate care is essential. Wound care planning requires wound assessment and identification of the aim of care. In turn, this supports dressing selection. Using an assessment framework can help ensure that this is done in a structured way. Reassessment and review of the care plan at agreed intervals is also recommended. In addition to the aim of care, other factors influence the choice of dressing. These include local formulary requirements and allergies and sensitivities. An extensive range of dressings is available and these can be grouped into 10 types: hydrocolloid; wound contact layer; hydrogel; gelling fibre; alginate; foam; absorbent pads; film; odour absorbent; and antimicrobial. Clinicians should use available resources to support decision making and consider continuity of care when selecting the dressing to be used.

Wound assessment and dressing selection: an overview.

Wound healing consists of four overlapping phases. Holistic assessment of a wound is essential and can confirm whether healing is progressing as anticipated. Frameworks can assist the clinician to conduct the assessment in a systematic way and to plan appropriate care for the patient. Dressings form a relatively small part of the overall care plan, but with such an array available the choice can be overwhelming. This article provides an update on wound assessment using the TIMERS framework and considers the factors influencing dressing choice.

Protein deimmunization via structure-based design enables efficient epitope deletion at high mutational loads.

Anti-drug immune responses are a unique risk factor for biotherapeutics, and undesired immunogenicity can alter pharmacokinetics, compromise drug efficacy, and in some cases even threaten patient safety. To fully capitalize on the promise of biotherapeutics, more efficient and generally applicable protein deimmunization tools are needed. Mutagenic deletion of a protein's T cell epitopes is one powerful strategy to engineer immunotolerance, but deimmunizing mutations must maintain protein structure and function. Here, EpiSweep, a structure-based protein design and deimmunization algorithm, has been used to produce a panel of seven beta-lactamase drug candidates having 27-47% reductions in predicted epitope content. Despite bearing eight mutations each, all seven engineered enzymes maintained good stability and activity. At the same time, the variants exhibited dramatically reduced interaction with human class II major histocompatibility complex proteins, key regulators of anti-drug immune responses. When compared to 8-mutation designs generated with a sequence-based deimmunization algorithm, the structure-based designs retained greater thermostability and possessed fewer high affinity epitopes, the dominant drivers of anti-biotherapeutic immune responses. These experimental results validate the first structure-based deimmunization algorithm capable of mapping optimal biotherapeutic design space. By designing optimal mutations that reduce immunogenic potential while imparting favorable intramolecular interactions, broadly distributed epitopes may be simultaneously targeted using high mutational loads.

Diabetic foot ulcers treated with hyperbaric oxygen therapy: a review of the literature.

Hyperbaric oxygen therapy (HBO) has been used as an adjunct for healing diabetic foot ulcers (DFUs) for decades. However, its use remains controversial. A literature search was conducted to locate clinical studies and assess the available evidence. Ten prospective and seven retrospective studies evaluating HBO for DFUs were located. These were reviewed and the outcomes were discussed. One study reported no difference in outcomes between patients receiving hyperbaric oxygen and the control group. However, their regime differed from all other studies in that the patients received hyperbaric oxygen twice rather than once daily. Reduced amputation rates and improved healing were the most common outcomes observed.

A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report.

We report long-term follow-up of a patient who underwent a tailored laparoscopic procedure for symptomatic cholelithiasis, massive splenomegaly, and a planned pregnancy. There were no complications, and the patient remained symptom-free at the 5-year follow-up. We supplemented our case report with national surgical data demonstrating the safety of laparoscopic splenectomy.

Tularemia cases increase in the USA from 2011 through 2019.

Tularemia is a rare but potentially serious bacterial zoonosis, which has been reported in the 47 contiguous states of the USA during 2001-2010. This report summarizes the passive surveillance data of tularemia cases reported to the Centers for Disease Control and Prevention from 2011 through 2019. There were 1984 cases reported in the USA during this period. The average national incidence was 0.07 cases per 100,000 person-years (PY), compared to 0.04 cases per 100,000 PY during 2001-2010. The highest statewide reported case 2011-2019 was in Arkansas (374 cases, 20.4% of total), followed by Missouri (13.1%), Oklahoma (11.9%), and Kansas (11.2%). Regarding race, ethnicity, and sex, tularemia cases were reported more frequently among white, non-Hispanic, and male patients. Cases were reported in all age groups; however, individuals 65 years-old and older exhibited the highest incidence. The seasonal distribution of cases generally paralleled the seasonality of tick activity and human outdoor activity, increasing during spring through mid-summer and decreasing through late summer and fall to winter lows. Improved surveillance and education of ticks and tick- and water-borne pathogens should play a key role in efforts to decrease the incidence of tularemia in the USA.

A retrospective study of diabetic foot ulcers treated with hyperbaric oxygen therapy.

A retrospective review of patient medical records was conducted to assess what factors influence the outcomes of diabetic foot ulcers treated with hyperbaric oxygen (HBO) therapy. Patients referred to the Diving Diseases Research Centre for HBO therapy for the treatment of diabetic foot ulcers during a 2-year period were included in this study. Data collected from 30 sets of patient records were entered into SPSS and statistical analysis was undertaken to investigate whether any underlying pathologies or confounding factors appeared to influence patient outcome. A 73.3% of patients achieved a successful outcome of partial healing, major amputation no longer required, amputation level lower than anticipated prior to HBO or healing at the end of HBO therapy and 70% remained successful 3 months later. A 13.3% of patients were lost to follow-up at 3 months and one patient (3.3%) had a major amputation. Steroid therapy, peripheral vascular disease, previous minor amputation, type of diabetes, previous HBO therapy, larvae therapy, the use of interactive dressings and haemoglobin A1c levels were all observed to have had a significant relationship with patient outcome (P < 0.05). These results were compared with data from other published research conducted in this area on similar patient groups. A larger scale study focussing on the factors found to be significant in this study is recommended. An improvement of patient documentation would allow patient outcomes to be more consistently monitored in the future.