RESUMO
Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.
Assuntos
Onicomicose , Adolescente , Humanos , Criança , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Antifúngicos/uso terapêutico , Unhas , Administração Oral , Europa (Continente)RESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) determine the prevalence of MRSA and MSSA colonization in DHCW in the region of Mecklenburg Western-Pomerania, Germany, (II) resolve the S. aureus population structure to gain hints on possible transmission events between co-workers, and (III) clarify use of PPE. Nasal swabs were obtained from dentists (n = 149), dental assistants (n = 297) and other dental practice staff (n = 38). Clonal relatedness of MSSA isolates was investigated using spa typing and, in some cases, whole genome sequencing (WGS). PPE use was assessed by questionnaire. While 22.3% (108/485) of the participants were colonized with MSSA, MRSA was not detected. MSSA prevalence was not associated with size of dental practices, gender, age, or duration of employment. The identified 61 spa types grouped into 17 clonal complexes and four sequence types. Most spa types (n = 47) were identified only once. In ten dental practices one spa type occurred twice. WGS data analysis confirmed a close clonal relationship for 4/10 isolate pairs. PPE was regularly used by most dentists and assistants. To conclude, the failure to recover MRSA from DHCW reflects the low MRSA prevalence in this region. Widespread PPE use suggests adherence to routine hygiene protocols. Compared to other regional HCW MRSA rates the consequent usage of PPE seems to be protective.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Atenção à Saúde , Pessoal de Saúde , Humanos , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/genéticaRESUMO
OBJECTIVES: In the search for more effective and safe treatment avenues, we investigated cold physical plasma as a new treatment modality for therapy of oral lichen planus (OLP). MATERIAL AND METHODS: Healthy and diseased human mucosal tissue samples with a size of 3 mm in diameter obtained from OLP patients were subjected to plasma treatment ex vivo or were left untreated. Tissue sections were quantified for immune-infiltration of CD4+ , CD8+ , CD45RA+ , and CD45R0+ T cells. Moreover, the tissues' inflammatory profile was assessed by analyzing 12 different cytokines in the surrounding media. RESULTS: A significantly increased infiltrate of CD8+ and CD45-R0+ T cells was detected in OLP tissue samples when compared to healthy tissue. A higher concentration of interleukin (IL) 1ß, IL6, IL8, and granulocyte macrophage-colony stimulating factor (GM-CMF) was detected in OLP samples compared to healthy mucosal tissue. For all cytokines and chemokines investigated, 23 out of 24 comparisons showed a decrease in tendency (significant for IL1ß, IL2, IL10, and GM-CSF) in response to plasma treatment. In ex vivo-treated tissue, a decrease of T-cell infiltrate in OLP lesions compared with healthy tissue was observed. CONCLUSION: Our findings suggest cold physical plasma can be a promising therapeutic option for OLP that requires further validation in vivo.
Assuntos
Líquen Plano Bucal , Gases em Plasma , Quimiocinas , Citocinas , Humanos , Líquen Plano Bucal/terapia , Linfócitos TRESUMO
OBJECTIVE: Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS: We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS: Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS: We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.
Assuntos
Febre de Causa Desconhecida/epidemiologia , Neoplasias Hematológicas/reabilitação , Hospedeiro Imunocomprometido , Reinfecção/epidemiologia , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/imunologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Neutropenia Febril/epidemiologia , Neutropenia Febril/imunologia , Feminino , Febre de Causa Desconhecida/imunologia , Alemanha/epidemiologia , Neoplasias Hematológicas/imunologia , Hospitais de Reabilitação , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Pancitopenia/epidemiologia , Pancitopenia/imunologia , Centros de Reabilitação , Reinfecção/imunologia , Estudos Retrospectivos , Risco , Transplante de Células-Tronco , Fatores de Tempo , Transplante HomólogoRESUMO
Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.
Assuntos
Antifúngicos/uso terapêutico , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Adulto , Criança , Cabelo/microbiologia , Humanos , Couro Cabeludo/microbiologia , TrichophytonRESUMO
Background: Hyperspectral Imaging (HSI) has a strong potential to be established as a new contact-free measuring method in medicine. Hyperspectral cameras and data processing have to fulfill requirements concerning practicability and validity to be integrated in clinical routine processes. Methods: Calculating physiological parameters which are of significant clinical value from recorded remission spectra is a complex challenge. We present a data processing method for HSI remission spectra based on a five-layer model of perfused tissue that generates perfusion parameters for every layer and presents them as depth profiles. The modeling of the radiation transport and the solution of the inverse problem are based on familiar approximations, but use partially heuristic methods for efficiency and to fulfill practical clinical requirements. Results: The parameter determination process is consistent, as the measured spectrum is practically completely reproducible by the modeling sequence; in other words, the whole spectral information is transformed into model parameters which are easily accessible for physiological interpretation. The method is flexible enough to be applicable on a wide spectrum of skin and wounds. Examples of advanced procedures utilizing extended perfusion representation in clinical application areas (flap control, burn diagnosis) are presented.
Assuntos
Diagnóstico por Imagem , Processamento de Imagem Assistida por Computador , Queimaduras , Humanos , Medicina , Perfusão , Retalhos Cirúrgicos , CicatrizaçãoRESUMO
The rare case of a 61-year-old patient suffering from linear IgA dermatosis is presented. The patient was previously hospitalized with chronic inflammatory bowel disease. The correct diagnosis of the disease was based on clinical and histological findings. Serological methods, such as indirect immunofluorescence, ELISA and immunoblotting are suitable for identification of the autoantibodies. In this case the detection of IgA antibodies along the basal membrane was achieved by direct immunofluorescence. Other bullous dermatoses with similar symptoms, such as an IgG-mediated bullous pemphigoid have to be excluded. The therapy of linear IgA dermatosis is ensured by steroid-containing topical agents, alongside antiseptic measures as well as systemic dapsone p.o.
Assuntos
Autoanticorpos/sangue , Vesícula/imunologia , Imunoglobulina A/sangue , Dermatose Linear Bolhosa por IgA/diagnóstico , Autoanticorpos/imunologia , Vesícula/tratamento farmacológico , Vesícula/patologia , Colite Ulcerativa/diagnóstico , Técnica Direta de Fluorescência para Anticorpo , Glucocorticoides/administração & dosagem , Humanos , Imunoglobulina A/imunologia , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Dermatose Linear Bolhosa por IgA/imunologia , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: The microbiome, collective microbial life in defined areas of the body, is of great importance. OBJECTIVE: What is the significance of the wound microbiome in the treatment of chronic wounds? Which interactions exist with other microbiomes and which conclusions can be drawn for wound management? MATERIALS AND METHODS: Swabs or debridement samples from wounds were analysed for microbial growth by culture or gene-based techniques. The genetic results are used to determine the wound microbiome. The pathogens were evaluated according to proportion of different species and related to different factors like type and location of wound, disease and underlying illnesses and to define the wound microbiome. RESULTS: In comparison with conventional microbiological detection methods the wound microbiome comprises many more types and quantities of species. The wound microbiome is related to skin microbiome showing complex and time-dependent composition, as well as inter- and intraindividual differences. Diabetic wounds exhibit disease-related changes, e.g. staphylococcal species dominate whereas streptococcal species dominate in nondiabetic wounds. CONCLUSIONS: The analysis of wound microbiome is still at an early stage; however it has already been shown that in hemodynamic disorders there are disease-specific relationships with the wound microbiome, which can also provide clues about the course of the disease. Phenomena from the skin microbiome should also be effective in wounds. In this context modern antimicrobial treatment options beyond conventional chemotherapy like colonization modulation become possible.
Assuntos
Anti-Infecciosos/uso terapêutico , Microbiota/efeitos dos fármacos , Pele/microbiologia , Cicatrização/efeitos dos fármacos , Antibacterianos/uso terapêutico , Desbridamento , Humanos , Microbiota/genética , Cicatrização/genéticaRESUMO
We investigated the prevalence of multidrug resistant pathogens in patients of oncologic and cardiologic rehabilitation units with 155 oncologic and 157 cardiologic patients undergoing microbiologic screening. It was found that 4.5% of oncologic as well as cardiologic patients were colonized with multidrug resistant pathogens. 2-MRGN and ESBL were the most encountered species (2.9%). 3-MRGN were found twice as frequent in oncologic patients (2.6 and 1.3%). Overall oncologic and cardiologic patients exhibit comparatively low prevalence rates for multidrug resistant pathogens.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Cardiopatias/microbiologia , Cardiopatias/reabilitação , Neoplasias/microbiologia , Neoplasias/reabilitação , Infecções Bacterianas/epidemiologia , Alemanha/epidemiologia , Cardiopatias/epidemiologia , Humanos , Neoplasias/epidemiologia , Prevalência , Resultado do TratamentoRESUMO
After surgical treatment of cancer of the esophagus or the esophagogastric junction we observed steatorrhea, which is so far seldom reported. We analyzed all patients treated in our rehabilitation clinic between 2011 and 2014 and focused on the impact of surgery on digestion of fat. Reported steatorrhea was anamnestic, no pancreatic function test was made. Here we show the results from 51 patients. Twenty-three (45%) of the patients reported steatorrhea. Assuming decreased pancreatic function pancreatic enzyme replacement therapy (PERT) was started or modified during the rehabilitation stay (in the following called STEA+). These patients were compared with the patients without steatorrhea and without PERT (STEA-). Maximum weight loss between surgery and rehabilitation start was 18 kg in STEA+ patient and 15.3 kg in STEA- patients. STEA+ patients gained more weight under PERT during the rehabilitation phase (3 wk) than STEA- patients without PERT (+1.0 kg vs. -0.3 kg, P = 0.032). We report for the first time, that patients after cancer related esophageal surgery show anamnestic signs of exocrine pancreas insufficiency and need PERT to gain body weight.
Assuntos
Terapia de Reposição de Enzimas/métodos , Neoplasias Esofágicas/cirurgia , Esteatorreia/tratamento farmacológico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Insuficiência Pancreática Exócrina/tratamento farmacológico , Insuficiência Pancreática Exócrina/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esteatorreia/etiologiaRESUMO
OBJECTIVE: Experimental tests of non-invasive multi- or hyperspectral imaging (HSI) systems reveal the high potential of support for medical diagnostic purposes and scientific biomedical analysis. Until now the use of HSI technologies for medical applications was limited by complex and overly sophisticated systems. We present a new and compact HSI-camera that could be used in normal clinical practice. METHOD: We assessed the use of the HSI system on the hands of 10 healthy volunteers, looking at control parameters, and those following venous occlusion, arterial occlusion and reperfusion, including tissue oxygenation, tissue haemoglobin index, perfusion in 4-6mm depth=near infrared spectroscopy (NIR), and tissue water index. Pseudo colours used ranged from 0% (blue) to 100% (red). We also assessed differences in the wounds of three patients. RESULTS: The results show good potential in all parameters in the healthy volunteers, which had high conformity with validated reference oximetry measurements. In three wounds, different levels of oxygenation were identified in the wound area, although interpretation of these results is complex. In Cases 2 and 3, following the application of a micro capillary dressing, improvements were seen in perfusion and reduction of the tissue water index (TWI). CONCLUSION: The camera system proved to be quick, flexible and yielded data with high spatial and spectral resolution. These data will be used to perform a power analysis for a randomised controlled study.
Assuntos
Bandagens , Imagem Óptica , Oxigênio/metabolismo , Ferimentos e Lesões/terapia , Adulto , Idoso , Queimaduras/diagnóstico por imagem , Queimaduras/metabolismo , Feminino , Humanos , Úlcera da Perna/diagnóstico por imagem , Úlcera da Perna/metabolismo , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Cicatrização , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/metabolismoRESUMO
BACKGROUND: Diagnosis and treatment of malignancies are frequently associated with a variety of problems for affected individuals and their relatives. In order to ensure adequate psycho-oncological and social care, it is recommended to routinely assess patients' psychosocial distress. While psychosocial services for inpatients have been expanded in recent years, the outpatient care structure in terms of psycho-oncological support is far from satisfactory, especially in Mecklenburg-Western Pomerania. We therefore set out to investigate the following questions: Does the need for psychosocial care vary in relation to (a) the treatment setting (inpatients vs. outpatients) and (b) the diagnosis? (c) Do patients experiencing psychological distress desire support? PATIENTS AND METHODS: We asked both inpatients and outpatients to rate their psychosocial situation using the Hornheide Questionnaire. Patients were also asked about their desire for psychological support and the preferred contact person. RESULTS: (a) The treatment setting had no impact on the need for psychosocial care and the desire for support. (b) Depending on the type of skin cancer, there were significant differences in the need for such care among the 251 patients surveyed. (c) Despite a certain discrepancy, there was a significant correlation between psychosocial distress (39.0 %; n = 98/251) and desire for support (14.3 %; n = 35/245). (d) Patients experiencing distress primarily chose physicians (n = 21) and psychologists (n = 20) as potential contact persons. CONCLUSIONS: (1) In addition to the level of distress, the desire for support should be inquired. (2) Recommendations by physicians represent an important means of access to psycho-oncological services. (3) Services for outpatient support should be expanded.
Assuntos
Neoplasias Cutâneas , Apoio Social , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/terapia , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone-iodine or polihexanide. Concomitant short-term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.
Assuntos
Anti-Infecciosos Locais/efeitos adversos , Sobrevivência Celular/efeitos dos fármacos , Desbridamento/métodos , Larva/efeitos dos fármacos , Larva/crescimento & desenvolvimento , Ferimentos e Lesões/terapia , Animais , HumanosRESUMO
BACKGROUND: Staphylococcus aureus may be the most important wound pathogen and causative for most of surgical site infections. As many anti-staphylococcal drugs are useless because of resistance, novel antimicrobial strategies are strongly needed and may be provided by cold atmospheric plasma (CP), which is being currently investigated for antiseptic efficacy. METHODS: To test the antimicrobial properties of CP against Staphylococcus aureus, 168 methicillin-susceptible isolates (MSSA) and 50 methicillin-resistant isolates (MRSA) were treated with two technically different plasma sources [an atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge plasma (DBD)] in vitro. RESULTS: CP treatment allowed a reproducible and significant growth reduction of MRSA and MSSA. However, MRSA was significantly less susceptible to treatment with DBD than was MSSA, while no difference between MRSA and MSSA was found using APPJ. CONCLUSIONS: As the initial physical antiseptic on skin, CP may be suitable for rapid decolonization of microbial pathogens in vivo. Each device must undergo validated efficacy testing prior to clinical application, as device related differences may occur.
Assuntos
Antibacterianos/farmacologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Gases em Plasma/farmacologia , Infecções Cutâneas Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Humanos , Modelos BiológicosRESUMO
HINTERGRUND: Der Verschluss von Wunden mit ausgeprägtem Weichteilschaden stellt eine chirurgische Herausforderung dar und erfordert häufig umfangreiche plastische Operationen sowie freie Lappenplastiken. Die Kombination von Dermisersatzpräparaten und Spalthauttransplantationen ist eine innovative Methode die zur Versorgung von komplexen Verletzungen der Extremitäten angewandt werden kann. Wir haben diese Technik in das Standard-Handwerkszeug bei komplexen Verletzungen der Extremitäten aufgenommen. Die klinischen Ergebnisse von 56 behandelten Patienten werden vorgestellt. PATIENTEN UND METHODEN: In 44 Fällen (78,6 %) wurde die beschriebene Methode an Defekten der unteren Extremitäten verwendet, einschließlich sieben Personen (12,5 %), die sich einer Stumpfdeckung nach Amputation unterzogen. Zwölf Defekte (21,4 %) befanden sich an den oberen Extremitäten. In zwei Fällen (3,6 %) wurde die Matriderm(®) -Matrix verwendet, um Nerven von unmittelbar angrenzenden chirurgischen Implantaten zu schützen. ERGEBNISSE: Bei 41 Patienten (73,2 %) kam es zur Einheilung des Transplantats ohne Komplikationen. Fünfzehn Patienten (26,8 %) zeigten eine gestörte Wundheilung nach Defektverschluss, die unter konservativer Therapie zur Ausheilung gebracht werden konnte. Ein Patient (1,8 %) zeigte ein Transplantatversagen, was eine Revisionsoperation erforderlich machte. Umfangreiche plastische Rekonstruktionen mussten bei keinem Patienten angewandt werden. SCHLUSSFOLGERUNGEN: Bei Fällen, in denen ausgedehnte plastische Operationen nicht möglich oder nicht erwünscht sind, ist die Verwendung von Dermisersatzpräparaten in Kombination mit Spalthauttransplantationen eine vielversprechende Alternative zum Wundverschluss bei ausgedehnten Weichteilschäden.
Assuntos
Procedimentos de Cirurgia Plástica , HumanosRESUMO
BACKGROUND: The closure of wounds associated with soft tissue defects is surgically challenging, frequently requiring extensive plastic surgery and free flaps. The combination of dermal skin substitutes and split-thickness skin grafting is an innovative method used to cover such wounds. We incorporated this technique into the standard therapeutic armamentarium for complex injuries to the extremities. Clinical results of 56 patients thus treated are presented. PATIENTS AND METHODS: In 44 (78.6 %) cases, the method described was used for defects on the lower extremities, including seven (12.5 %) individuals undergoing amputation stump coverage. Twelve (21.4 %) defects were located on the upper extremities. In two (3.6 %) cases, Matriderm(®) matrix was used to protect nerves from adjacent surgical implants. RESULTS: In 41 (73.2 %) patients, the graft healed without any complication. Fifteen (26.8 %) patients displayed impaired wound healing following defect closure and were subsequently managed conservatively. One patient (1.8 %) showed graft failure, leading to revision surgery. None of the patients required extensive plastic surgery. CONCLUSIONS: In cases where plastic surgery is unavailable or undesirable, the use of dermal skin substitutes in combination with split-thickness skin grafting represents a promising alternative for covering wounds associated with soft tissue defects.
Assuntos
Procedimentos de Cirurgia Plástica , Transplante de Pele , Pele Artificial , Humanos , Estudos Retrospectivos , Lesões dos Tecidos MolesRESUMO
BACKGROUND: An important basis for adequate psycho-oncological and psychosocial care of cancer patients is the regular assessment of their psychosocial distress and thus their need for care. For this purpose, there are numerous questionnaires available. The objective of the present study was to assess whether distressed patients require professional support and which screening instrument outpatients with skin cancer prefer. PATIENTS AND METHODS: In a cross-sectional survey, we asked outpatients with skin cancer to fill out three questionnaires assessing psychosocial stress, and to indicate which one they considered most adequate. Patients were offered the following three instruments: Hornheide Questionnaire (27 items), Hornheide Screening Instrument (7 items), and the Distress Thermometer. In addition, we inquired about the patients' desire for support. RESULTS: (1) Comparing subjective distress and patients' declared desire for support revealed a marked divergence. While one-third of the 137 patients were identified as being in need of care, only 11.5% of the sample requested such support. (2) 63.7% of patients chose the long version of the Hornheide Questionnaire. CONCLUSIONS: In addition to their psychosocial burden, patients' desire for support should be assessed. Moreover, apart from screening tools, other ways to provide access to psychosocial care should be considered.
Assuntos
Pacientes Ambulatoriais/psicologia , Preferência do Paciente/estatística & dados numéricos , Neoplasias Cutâneas/psicologia , Apoio Social , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto , Assistência ao Convalescente/psicologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Pacientes Ambulatoriais/estatística & dados numéricos , Psicologia , Psicometria/métodos , Qualidade de Vida/psicologia , Distribuição por Sexo , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/terapia , Estresse Psicológico/epidemiologia , Estresse Psicológico/terapia , Adulto JovemRESUMO
BACKGROUND: Today, highly sophisticated devices deliver cold atmospheric pressure plasma (CAPP) with a multitude of bioactive properties, opening the window to a new medical field: plasma medicine. Different techniques to create the optimal plasma device for different medical indications are currently being explored. However, even a 100 years ago, CAPP was briefly used in the related form of high-frequency therapy. The objective of our study was to compare historic with modern techniques regarding antimicrobial efficacy. METHODS: First, 26 different clinical isolates of relevant wound pathogens were treated in vitro with a historic violet wand (VW) and 2 modern plasma sources (kINPen 09 and dielectric barrier discharge [DBD]) and the obtained inhibition areas (IAs) were compared. Second, a biofilm model was used to compare biofilm inactivation by VW, DBD, ethanol, and polyhexanide treatment. RESULTS: DBD with the largest electrode produced the largest IAs. VW showed results similar to 2 different modes of the kINPen 09. IAs of VW were enlargeable by attaching a larger electrode. Against biofilms, VW was less effective than DBD but more effective than ethanol 70% and polyhexanide. CONCLUSION: The proven antimicrobial efficacy of VW may encourage the development of new, potent plasma devices based on the very simple and inexpensive technique of the historic high-frequency apparatus.
Assuntos
Anti-Infecciosos/química , Anti-Infecciosos/farmacologia , Bactérias/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Engenharia Biomédica/instrumentação , Engenharia Biomédica/métodos , Gases em Plasma/química , Gases em Plasma/farmacologia , Eletrodos , Desenho de Equipamento , Modelos BiológicosRESUMO
BACKGROUND AND OBJECTIVES: Novel concepts to limit the spread of multidrug-resistant bacteria (MDR) are urgently needed. Since treatment with cold atmospheric plasma (CAP) has shown significant antibacterial properties, the purpose of this study was to evaluate the ability of CAP to eliminate MDR- compared to non-MDR-pathogens in chronic wounds. METHODS: Eleven patients with 18 heavily colonized wounds were treated with a CE-certified commercial argon-based CAP source for 10 s/cm(2) in one session. The antimicrobial efficacy was assessed by calculating the microbial load before and after treatment. RESULTS: A single CAP treatment reduced MDR in all wounds. In 14 treatments (63.6 %) and for 16 pathogens (66.7 %), a 100 % reduction of the bacterial load was observed. For 11 of 17 (64.7 %) MDR-pathogens and for 5 of 7 (71.4 %) other non-MDR-pathogens, complete eradication was achieved. The remaining 8 treatments showed reductions of 77.5 ± 18.6 % and the remaining pathogens a reduction of 74.8 ± 25.7 %. CONCLUSIONS: As proof of principle, argon-based CAP serves as a potent treatment modality that was shown to limit MDR microbial colonization. The possible role of CAP in clinical MDR decontamination must be evaluated in clinical trials with repeated plasma treatment embedded in a comprehensive hygienic decontamination concept.