Deep tissue culture and hemoculture in dogs with wounds and sepsis / Cultura de tecido profundo e hemocultura em cães com feridas e sepse

Contaminated and infected wounds occur very frequently in veterinary medicine and can cause systemic inflammatory response syndrome, sepsis, and death. This study aimed to test the feasibility of collecting wound material by deep-tissue or punch biopsy for microbial culture, determine the frequency of bacteria in the wound(s) and blood cultures and the susceptibility of these microbes to antimicrobials, and evaluate clinical parameters that could be related to prognosis. Thirty dogs with wounds and signs of SIRS/sepsis were included in this study. Bacteria were isolated from all wounds and 41 bacterial isolates could be identified based on culture of the materials collected by punch biopsy; 53.66% of the isolates were gram-negative, mainly involving Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus spp., and 46.34% were gram-positive bacteria such as Streptococcus spp., Enterococcus spp., and Staphylococcus spp. The survival rate was 66.67%. Based on blood culture analysis, we identified bacteremia in seven patients, predominantly of gram-negative bacteria, which negatively affected patient survival, as six dogs died. Hypoglycemia (≤60mg/dL) and severe hyperglycemia (≥180mg/dL) also negatively affected survival as 23.33% of the hypo/hyperglycemic dogs died. Factors such as blood lactate level at admission and hematocrit levels, and mean arterial pressure were not significantly correlated with death or survival of the dogs.(AU)

As feridas contaminadas e infectadas em cães ocorrem com grande frequência na medicina veterinária e podem causar síndrome da resposta inflamatória sistêmica, sepse e morte. Os objetivos do presente trabalho foram verificar a viabilidade da técnica de coleta de material da ferida por biópsia para realização de cultura microbiana, determinar a frequência das bactérias nas culturas das feridas e hemoculturas e a susceptibilidade destes agentes aos antimicrobianos, bem como avaliar parâmetros clínicos que pudessem ser relacionados ao prognóstico em 30 cães com feridas e sinais de SIRS/sepse. Foram isoladas bactérias de todas as feridas e a técnica de coleta de material para cultura por biópsia permitiu a obtenção de 41 agentes microbianos, sendo isoladas 53,66% bactérias Gram negativas e 46,34% Gram positivas, principalmente Pseudomonas aeruginosa, Klebsiella pneumoniae e Enterococcus spp. As bactérias gram positivas isoladas foram Streptococcus spp., Enterococcus spp. e Staphylococcus spp. A taxa de sobrevivência foi 66,67%. Na hemocultura constatou-se bacteremia em sete pacientes, com predominância de bactérias Gram negativas, o que influenciou negativamente na sobrevivência dos pacientes, pois seis cães vieram a óbito. A hipoglicemia (≤60mg/dL) ou hiperglicemia severa (≥180mg/dL), também influenciaram negativamente a sobrevivência, pois 23,33% dos pacientes hipo/hiperglicêmicos vieram a óbito. Já fatores como nível sérico de lactato na admissão do paciente, pressão arterial média (PAM) e hematócrito não apresentaram correlação estatística com o óbito ou sobrevivência destes pacientes.(AU)

Clínica de heridas y estomas, una propuesta de enfermería especializada / Clinic of wounds, and stomata, a proposal for specialized nursing

Las lesiones de la integridad de la piel, las úlceras por presión (UPP) en pacientes hospitalizados representa un problema importante debido a su prevalencia, a la vez que afecta la calidad de vida del paciente, e implican consecuencias socioeconómicas para la persona, familia e instituciones de salud, ya que aumenta la morbimortalidad, su prevención y manejo competen en gran parte al profesional de enfermería

The lesions of skin integrity, pressure ulcers (UPP) in hospitalized patients is a major problem because of its prevalence, while affecting the quality of life of patients, and involve socioeconomic consequences for the individual, family and health institutions, increasing morbidity and mortality, prevention and management competence largely to nurse

Infecciones en niños quemados / Infections in children with burn injuries

La infección es una causa muy importante como factor de complicaciones y como determinante en las consideracio-nes de alto riesgo, especialmente en niños de corta edad. Enfermería cumple un rol esencial y, en el cual, no escatima esfuerzos para el logro de un excelente resultado, en beneficio de la sobrevida y la calidad de vida, la misma estará deter-minada primordialmente por la infección, y el pronostico del niño quemado. La incidencia de complicaciones infecciosas es directamente proporcional al porcentaje de la quemadura, relacionada con la profundidad de la misma. El objetivo de este trabajo es proporcionar conocimientos actualizados a través de una búsqueda bibliográfica disponible y de nuestra experiencia en la atención de los niños quemados, nos refe-riremos a la flora encontrada mas frecuentemente en nuestra unidad y los cuidados efectuados para prevenir y/o dismi-nuir la contaminación o infección en los niños atendidos en la unidad de cuidados intensivos pediátricos de pacientes quemados.

The infection is a cause very important as factor of complica-tions and a determining factor in considera-tions of high risk, especially in young children. Nursing plays an essential role and, which spares no effort for the achievement of an excel-lent result, for the benefit in survival and quality of life, it will be determined primarily by the infection, and the prognosis of the burned child. The incidence of infectious complications is directly proportional to the percentage of the burn, the depth of it-related. The objective of this work is to provide updated through a literature search available knowledge and experience in the care of burned children, we refer to the flora found more frequently in our unit and care incurred to prevent or reduce pollution or infection in children treated at the unit of pediatric intensive care of burned patients.

Caracterização das vítimas de queimaduras em seguimento ambulatorial / Characterization of victims of burns on outpatient follow-up program

Objetivo: Esta pesquisa teve como objetivo caracterizar as vítimas de queimaduras em seguimento ambulatorial. Método: Estudo de corte transversal, de campo com abordagem quantitativa, realizado nos meses de agosto a dezembro de 2009, por meio de entrevista estruturada. A amostra foi constituída de 100 vítimas de queimadura que estavam sendo acompanhadas no ambulatório de Cirurgia Plástica de Aracaju-SE. Resultados: As vítimas eram em sua maioria do sexo masculino (65%), crianças e jovens com idade até 25 anos (73%), causada por lesão térmica (81%) com predominância de líquido superaquecido (59%), ocorridas no domicílio (64%), de forma acidental (94%) e não oriundas da capital, onde está localizado o ambulatório.

Objective: This study aimed to characterize the victims of burns in outpatients. Methods: Cross-sectional study of the field with a quantitative approach, carried out from August to December 2009, through a structured interview. The sample consisted of 100 burn victims who were being followed at the outpatient clinic of Plastic Surgery in Aracaju, Sergipe, Brazil. Results: The results revealed that the victims were mostly male (65%), children and young people aged 25 years (73%) caused by thermal injury (81%) with predominance of super heated liquid (59%) occurred at home (64%), accidentally (94%) and not derived from the capital, where the clinic is located.

Terapia con presión negativa vs. cierre convencional en fracturas abiertas con heridas complejas / Negative pressure therapy vs. conventional closure in open fracture with complex wounds

El objetivo evaluar la utilidad del tratamiento de heridas con presión negativa (TPN) en el entorno de alta energía fracturas abiertas de miembros inferiores y comparar el tiempo de cierre con respecto al protocolo de cierre diferido de estas lesiones. Se trata de una serie consecutiva retrospectiva en el hospital IVSS de Ciudad Ojeda, Clínica Paraíso y Hospital Corómoto de Maracaibo, Población: 8 pacientes consecutivos que acudieron entre el 2010 y 2011 con 7 fracturas abiertas grado III y 1 heridas contaminadas postquirúrgicas, Las heridas abiertas asociadas a fractura fueron tratadas cada una con TPN antes del cierre de la herida o la cobertura definitiva y se comparo con 7 pacientes con fracturas abiertas con cierre diferido de acuerdo al protocolo aplicado en la institución para el manejo de estás lesiones, se midió el tiempo de cierre, la tasa de infección y tasa de reoperación de ambas series. El tiempo promedio de cierre con TPN fue de 5 días en rango que oscilo entre 4 y 12 día en comparación con el cierre de acuerdo al protocolo con un promedio de 28 días. No se reporto infecciones durante y posterior a su uso. El uso de TPN es eficaz para el control de heridas por fracturas abiertas y al cierre y drenaje de heridas postquirúrgicas infectadas, reduce el tiempo de cierre y no se consiguió complicaciones a su uso

The objective to evaluate the usefulness of treating wounds with negative pressure (NPWT) in the high-energy environment of open fractures of lower limbs and to compare the time close to the protocol of delayed closure of these lesions. This is a retrospective consecutive series in the hospital IVSS of Ciudad Ojeda, Clínica Paraíso y Hospital Corómoto de Maracaibo, Population: 8 consecutive patients presenting between 2010 and 2011 with 7 grade III open fractures and contaminated wounds 1 postsurgical wounds associated with open fractures were treated each with NPWT before wound closure or definitive coverage was compared with 7 patients with open fractures with delayed closure according to the protocol implemented in the institution for the management of these lesions, we measured the closure time, the rate of infection and reoperation rate of both series. The average closing time with NPWT was 5 days in range of between 4 and 12 days compared with the closure according to the protocol with an average of 28 days. No infections were reported during and after use. The use of NPWT is effective for control of open fractures and wounds to close and infected postoperative wound drainage, reduce the closing time and got no complications with its use

Nontuberculous Mycobacterial Tenosynovitis in the Hand: Two Case Reports with the MR Imaging Findings

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.

VAC artesanal: una técnica para el manejo de fístulas complejas con abdomen abierto: reporte de 2 casos / Hand made VAC: a technique used in the handling of complex fistulas with open abdomen: 2 cases report

Las fístulas gastrointestinales asociadas con abdomen abierto posterior a trauma o cirugía abdominal mayor son una complicación grave. El manejo es extremadamente dífícil y la mortalidad bastante alta a pesar de los modernos avances médicos. Aquellos pacientes que sobreviven al daño metabólico y fisiopatológico inicial requieren en su mayoría cierre quirúrgico de la fístula lo cual es técnicamente complejo y pobremente descrito en la literatura. Presentar una técnica efectiva para controlar la contaminación de la pared abdominal y el drenaje de las fístulas en pacientes con abdomen abierto. Se describen dos casos de pacientes con fístulas complejas de alto gasto y abdomen abierto quienes recibieron soporte nutricional y manejo con VAC artesanal. La literatura internacional describe el uso del cierre asistido por vacío (VAC) en el manejo de fístulas en pacientes con abdomen abierto. Se instauró un sistema de VAC "artesanal" utilizando una bomba de aspiración Medi-Pump modelo 1130, gasa vaselinada y/o goma espuma estéril y tubo de tórax 32. Para lograr el vacío se cubrió el abdomen con "envoplast". Ambos pacientes evolucionaron favorablemente, se logró recuperar el estado nutricional, controlar la infección, el gasto de la fístula y mejorar notablemente las condiciones locales. En uno de los casos se logró el cierre espontáneo de la fístula y el otro fue intervenido realizándose cierre quirúrgico. El cierre asistido por vacío artesanal y el manejo nutricional adecuado permite la mejoría en pacientes con fístulas complejas logrando las condiciones adecuadas para el cierre definitivo.

epidemiology of burn wound infections in patients hospitalized in burn center of Hamedan, Western Iran

A total of 465 burned patients with wound infections who admitted to referral burns center of Hamedan Imam Khomeiny hospital from July 1998 to June 2001 were retrospectively studied. The required data including age, sex, season, causes of burns, burn size of wounds and types of organisms isolated from patients [wounds and blood], was recorded in a questionnaire. The susceptibility of the isolates to eight routine antibiotics was tested by disc diffusion method.The data was analyzed by SPSS and EP16 software package. Out of 465 burn wound infections 73.1% of isolates were Gram-negative bacilli and 26.9% were Gram-positive cocci. Pseudomonas aeruginosa [32.7%], Klebsiella pneumoniae [21.8%] and Staphylococcus aureus [21.2%] were the most common isolates. In 28.7% of patients, blood culture became positive, Klebsiella pneumoniae [30.4%], Pseudomonas aeruginosa [26.9%], were predominant isolates. 57.3% of patients were males and the most frequency of burn patients belonged to age group 0-9 years old [28.6%], most of the burns occurred during summer. Boiled water, fuel oil flames and firewood flames were the commonest causative agent for burns, respectively. The most effective antibiotics against isolates were ciprofloxacin, ceftizoxime, amikacin and gentamicin, while most of isolates showed high resistance to ampicillin, tetracycline and carbenicillin. Present results indicated that Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus were predominant isolates with high resistance to tested antibiotics. These data can be used to evaluate the effects of changes in burn treatment and antimicrobial resistance development in relation to antibiotic usage

Implicaciones médico-legales de las perforaciones corporales / Medical-legal implications of body piercings

La perforación corporal es una actividad cada vez más común en nuestro medio, por lo tanto es de importancia tanto para el médico como para el especialista en medicina legal pues ya se les exige que tengan un amplio conocimiento acerca de la técnica correcta de la perforación corporal, de los cuidados necesarios y las principales complicaciones de los piercings. En la prática hospitalaria hoy día es frecuente encontrarse con personas que consultan ya sea porque desean colocarse un piercing y quieren escuchar un consejo de su médico o personas que consultan a causa de las múltiples complicaciones que pueden ocurrir.

Complete abdominal wound dehiscence: evaluation of the non-operative management

Complete abdominal wound dehiscence "burst abdomen" is a challenging surgical complication and continue to be a major source of morbidity and mortality after laparotomies. The costs for managing burst abdomen are considerable, frequently requiring medical treatment, surgical intervention and prolonged hospital stay. Twenty six patients, who had burst abdomen, were seen between December; 2000 and April 2004 at Ain Shams University Hospitals. Fifteen patients were selected for conservative treatment [group A] and eleven patients were treated by classical abdominal mass closure with tension sutures [group B]. Patients selected for conservative treatment included those whose disruption occurred from the second postoperative week onwards, disruption occurred secondary to major wound sepsis or any intra-abdominal septic focus draining through the wound [without any evidence of intra-abdominal collections] or those with stable dehisced fascial defect that occurred at any time and under any circumstances, revealing amalgamated loops of bowel, which were adherent to wound edges [frozen abdomen]. Patients not falling into these categories were treated by mass closure. The mean hospital stay was 25 days in group A and 22 days in group B. Mortality was 20% [3 cases] among group A, all of them died in the early postoperative period from complications unrelated to the conservative protocol. Mortality was 36.4% [4 cases] among patients of group B, 50% of them died from intra-operative mishaps occurred at the time of closure [small intestinal injury]. Follow-up for 8 months or more was complete in 10 patients in group [A] and in 7 patients in group [B]. Four incisional [ventral] hernias were noted among 10 patients treated conservatively and followed up for more than 8 months. Repair was required in two patients [20%]. The other two patients had only diffuse protrusion during coughing or straining because of stretched weak scar without localized defects and required no further treatment. Two ventral hernias [28.6%] with multiple defects were seen in the survived 7 patients of group B, both of them has been repaired using polyprolene mesh. The results of this study strongly document the safety and efficacy of conservative treatment as an alternative method in treating abdominal wall dehiscence in certain situations. We believe this to be the method of choice in cases where the bowel loops are adherent to the wound edges, where the wound is infected and oedematous, when closure can only be done under tension and in high risk patients unfit for operation

Avaliação do efeito da oxigenoterapia hiperbárica no tratamento das infecções necrosantes pelviperineais / Evaluation of the effect of hyperbaric oxygen therapy in the treatment of pelviperineal necrotizing infections

As infecções necrosantes pelviperineais (INPPs) são infecções graves, pouco comum, com mortalidade aproximada em torno de 30 por cento de flora bacteriana mista e predomínio do sexo masculino. Objetivo: avaliar o efeito da oxigenoterapia hiperbárica (OHB) no tratamento das INPPs. Método: estudo clínico prospectivo randomizado realizado no Serviço de Cirurgia de Emergência do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / The pelviperineal necrotizing infecctions are serious infections, relatively rare, with mortality approached around 30 por cent of mixed bacterial flora and prevalence of masculine sex. Objective: to evaluate the effect of hyperbaric oxygn (HBO) therapy in the treatment of pelviperineal necrotizing infections. Method: prospective randomized clinical study accomplished in the Service of Emergency Surgery at the Clinical Hospital of the School of Medicine at the University of São Paulo in the period from July 2000 to November 2002...

Frecuencia de infecciones en heridas quirúrgicas en el servicio de obstetricia del Hospital Dr. Carlos Arvelo / Frequency of infectious in injuries surgical in the service obstetric of the Hospital Militar Hospital Dr. Carlos Arvelo

El desarrollo de infección en la herida, luego de un procedimiento quirúrgico es un problema frecuente. Este estudio tuvo como finalidad determinar de manera retrospectiva la incidencia de estas complicaciones en el Servicio de Obstetricia del Hospital Militar "Dr. Carlos Arvelo" de Caracas, mediante la revisión de los datos contenidos en las historias médicas. Entre los meses de enero a diciembre del 2001, ingresaron 453 pacientes al Servicio de Obstetricia, 47,6 por ciento de las cuales fueron intervenidas quirúrgicamente, siendo la cesárea segmentada la cirugía más frecuente. Sólo el 6,01 por ciento de las pacientes presentaron infección de la herida operatoria, manifestandose esta complicación 2 o 4 días luego de egresar del Hospital (86 por ciento). En cuanto a la etiología predominaron los cocos Gram positivos (Staphylococcus aureus, Staphylococcus coagulasa negativa) sensibles ambos a las Penicilinas resistentes a las penicilinasas, Penicilinas más inhibidores de la B-lactamasas, y Cefalosporinas de 1era. Generación

Riesgo anestésico y tipo de heridas asociados a infección intrahospitalaria en pacientes quirúrgicos: Modelo logístico / Anesthesic risk and type of injury associated to intrahospitalary infection in surgical patients: Logistic pattern

Con el fin de evaluar la asociación entre edad del paciente, el riesgo anestésico (ASA), el tipo de herida (limpia, limpia-contaminada, contaminada y sucia), y la duración del procedimiento quirúrgico con la presentación de infección intrahospitalaria (infección de herida quirúrgica, neumonía, infección del tracto urinario, infección de piel, conjuntivitis e infección de quemadura), se desarrolló un estudio controlado con 104 casos y 144 controles seleccionados aleatoriamente de los pacientes que ingresaron al piso quirúrgico del Hospital de Caldas (Cirugía General, Neurocirugía, Ortopedia, Urología). Se tomaron como criterios de infección intrahospitalaria (IIH) los que están estandarizados por el Centro de Control de Enfermedades de Atlanta (CDC). Mediante regresión lineal se escogieron las variables explicativas que fueron ingresadas al modelo de regresión logística (RL). De este último se excluyeron la edad del paciente y la duración del procedimiento por falta de significancia. En una fase posterior se diseñaron variables dummy para el ASA y el tipo de herida, evidenciándose asociación de la IIH con el ASA 3, el ASA 4, el ASA 5, la herida contaminada y la sucia. Cuando se corrió el modelo de RL con todas las variables independientes, tomando solo como variable respuesta la infección de la herida quirúrgica (IHQ) se encontró que ningún factor estaba asociado. El riesgo de IIH es alto para pacientes que ingresaron al hospital de Caldas y que poseen riesgos anestésicos altos (ASA 3, 4 y 5) y su tipo de herida es contaminada o sucia

Incisional hernias: why do they occur?

Over a period of five years 110 cases of incisional hernia were evaluated at teaching hospitals of Dow Medical College and Peoples Medical College, Nawabshah to ascertain their causes. It was found that these hernias were seen more frequently after emergency surgery [87.27%] performed by resident surgeons [89.09%]. About 70% patients had previous history of gynaecological and obstetric operations. Midline incision is more prone to herniation than paramedic and transverse incisions as evidenced by 73.64% patients in this series. Other important causative factors are wound infection [69.09%], chest infection [30.91%], abdominal distension [14.55%] and constipation

Infección de heridas post-apendicectomia en el Hospital Pablo Arturo Suarez 1990-1995

El presente es un estudio descriptivo retrospectivo, que determina la incidencia de heridas quirurgicas infectadas post-apendicectomia, en el período comprendido entre, enero de 1990 a diciembre de 1995. Se encontró un número total de 55 pacientes diagnosticados de herida infectada post-apendicectomia y que fueron sometidos a intervención quirurgica de emergencia (apendicectomia) para la resolución satisfatoria de su patología de base (apendicectomía) para la resolución satisfactoria de su patología de base (apendicitis aguda), y en los cuales se encontraron los siguientes resultados. La incidencia de infecciones quirurgicas post-apendicectomía es del 10.35 por ciento (n=55), de acuerdo al sexo masculino es del 54.55 por ciento (n=30) y al femenino 45.45 por ciento(n=25), el promedio de edad de presentación es de 29.6 años (R= 11-62 años), el tipo de incisión que presentó mayores casos de infección fue la infraumbilical media 60 por ciento(n=33), la apendicitis aguda perforada purulenta se asocio con mayor frecuencia a infección de la herida quirurgica en 70.9 por ciento (n=39), el tiempo quirurgico en promedio fue de 1.83 hs (R=30 min - 4 hs). El promedio de días para el diagnostico fue de 4.23 días, (R= 2-7 días). El tratamiento para resolver esta complicación se basó en curación de la herida en forma exclusiva 54.5 por ciento (n=30) y en curación más antibióticoterapia 45.5 por ciento (n=25).