Application Of The Enzymatic Debridement Of Burn Wounds In Patients During The Covid-19 Epidemic.

The unfolding pandemic necessitated optimalization of treatment methods and assurance of the highest precautionary standards to prevent transmission of COVID-19 to burn patients. One of them included an expanded access treatment with the minimally invasive method - enzymatic burn wound debridement using Nexobrid concentrate. The study assessed the effectiveness and usefulness of the expanded treatment project using enzymatic burn wound debridement with Nexobrid concentrate in patients (n=11) during the pandemic (2020) when compared with the results of the same method in a corresponding period of 2019. The concentrate was applied to the wound on the third day following injury at the latest. All patients were treated with the same accepted standards, including initial debridement of the wound, application of Nexobrid concentrate, and removal of devitalized tissue and dressing. Clinical visual assessment of the wound sites confirmed successful debridement of dead tissue following the application of the concentrate. No allergic or adverse reaction, nor significant deterioration of CBC parameters were observed in any patient. Although surgical excision of necrosis is recognized as the method of choice, enzymatic wound debridement using Nexobrid concentrate may contribute to a reduction in epidemiological risk when treating burn patients for several reasons; the procedure can be performed at the patient's bedside, it limits the number of required surgeries, helps to improve medical equipment and supplies management, and saves human resources.

La pandémie incontrôlée a nécessité une optimisation du traitement et des précautions d'hygiène maximales vis à vis des brûlés. Une d'entre elles consistait en l'utilisation de méthodes peu invasives dont l'excision enzymatique au Nexobrid . Cette étude compare l'efficacité et l'utilité l'utilisation larga manu de Nexobrid chez 11 patients pendant la période COVID (2020), comparée à son utilisation habituelle dans la période précédente. Ils bénéficiaient tout du même protocole à savoir nettoyage des plaies, application du Nexobrid au plus tard à J3 puis dépose du tissu nécrotique avec le pansement, confirmé par l'examen de la plaie. Nous n'avons observé ni allergie ni anomalie hématologique. Bien que la technique chirurgicale reste le traitement de référence, l'excision enzymatique peut limiter le risque épidémique qui y est lié car elle peut être réalisée au lit du patient, car elle diminue le nombre d'interventions chirurgicales, car elle permet d'améliorer les équipements, car elle diminue le nombre d'intervenants.

Impact of multiple medical interventions on mortality, length of hospital stay and reepithelialization time in Toxic Epidermal Necrolysis, Steven-Johnsons Syndrome, and TEN/SJS Overlap - Metanalysis and metaregression of observational studies.

Stevens-Johnson's Syndrome (SJS) and Toxic Epidermal Necrolysis are rare, life-threatening dermatologic conditions with acute onset and not clearly established treatment protocol. A plethora of observational studies are present with lack of up-to-date consensus based on evaluation of objective endpoints, among others mortality. Thorough analysis of available databases (Pubmed, EMBASE, Cinahl, Web of Science, Clinical Trials) was conducted according to PRISMA guidelines. Authors initially identified 700 papers, with 82 of them potentially eligible according to adopted criteria. A total of 42 studies were included into pooled synthesis. For continuous outcomes we analyzed the pooled means for endpoint scores using observed cases data. Categorical outcomes were analyzed by calculating the pooled event rates. We conducted subgroup and exploratory maximum likelihood random effects meta-regression analyses regarding SCORTEN of all outcomes. Using random-effects model, the overall pooled Mortality Rate was 0.191 (95%CI, 0.132-0.269). The lowest mortality rate was found to be linked with Etanercept and highest in Total Plasma Exchange (TPE) and Intravenous Immunoglobulin (IVIG). Overall reepithelization was 13.278 days (95%CI, 8.773-17.784),The highest was found in cyclosporine treatment; 14.739 whilst the lowest for steroids. Length of hospital stay in overall analysis was 19.99 days (95%CI, 16.53-23.44),the highest was linked with TPE/TPE+IvIg treatment, the lowest with steroids. Risk of bias of assessed studies was estimated to be high (for observational studies mean STROBE score 12.44). High quality TEN and SJS studies are lacking. Almost all papers report observational data without randomization and double-blind control. Therefore, the pooled analysis cannot be presented with initial bias. In our meta-analysis the most successful regimen was Etanercept treatment. It was linked with the lowest mortality. The most negative treatment outcome was observed in studies reporting TPE and IVIG. Randomized trials of high quality are needed in SJS and TEN.

The effect of chemo- and chemoimmunotherapy on the presence of circulating melanoma cells in peripheral blood. Preliminary results.

Reverse transcription and polymerase chain reaction (RT/PCR) with primers specific for tyrosinase allow for a new method of early detection of individual melanoma cells in peripheral blood. Using this test the effect of chemo- and chemoimmunotherapy on the spread of early micrometastatic cancer cells has been evaluated. No significant correlations have been found between RT/PCR results on the one hand and stage of disease, a kind of the therapy protocol used and usage of the therapy as an adjuvant or palliative on the other hand. Thus, although the RT/PCR test for detection of circulating individual melanoma cells might help in identification of minimal residual disease in some patients, it has no application for routine staging of more advanced disease and in monitoring the response to therapy.

Serum cytokine levels (IL-4, IL-6, IL-8, G-CSF, GM-CSF) in burned patients.

The presence and concentration of selected cytokines (interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 8 (IL-8), granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were evaluated in the sera of 12 burned patients (6-90 per cent body surface area). The presence of cytokines in the sera of 20 healthy volunteers (control group) was always undetectable (< 2 pg/ml). In sera of the burned patients the concentrations of IL-4 or GM-CSF were also below the test sensitivity levels, while G-CSF and IL-6 were present throughout all the observation period and IL-8 was detectable at the onset of massive infections. The serum concentrations of G-CSF and IL-6 increased during the episodes of clinically and bacteriologically detectable infections. Their increases were, however, observable 12-24 h later than the other infection symptoms. Similar increases in G-CSF and IL-6 levels have been detected during corrective surgery (covering of granulation tissue with skin grafts). It may be concluded that serum G-CSF and IL-6 levels in burned patients may be considered as diagnostic factors, but the delays in the reaction to the massive infection do not allow us to use them for predicting the time of onset of the infection.

Concentrations of selenium and lipid peroxides and glutathione peroxidase activities in plasma of thermally injured pigs.

The mechanism of behaviour of parameters involved in protection of the cell from oxidative damage in burn disease remains unclear. Therefore, selenium and lipid peroxide (MDA) levels, and glutathione peroxidase (GSH-Px) activities have been measured for one month in plasma of thermally injured young pigs. Immediately post-burn mean MDA level and GSH-Px activity decreased, while Se concentration increased. After 3 week lipid peroxide levels reached top concentration. Only the enzyme activity returned to initial value at the end of the study, whereas the other two parameters were below the content noted at the beginning. The Se concentration was significantly and positively correlated with GSH-Px activity, and negatively with MDA levels. The similar relationship was also showed for the enzyme and lipid peroxides. The results indicate an interesting role of the studied agents in burn disease, but still suggestions of treatment of severely burned patients with antioxidants need to be supported by detailed studies.