Un estudio comparativo de complicaciones agudas Apendicitis en el Hospital Universitario Al-Basra. Un estudio clínico prospectivo / A Comparison Study of Acute Complicated Appendicitis in Al-Basra Teaching Hospital. A Prospective Clinical Study

Background: Acute appendicitis is one of the most frequent surgical emergencies and is a common cause of non-traumatic acute abdominal emergencies that require surgical intervention. Most complicated appendicitis started de novo as simple appendicitis raising the notion that it is a disease in evolution that has become of clinical importance due to delayed or missed diagnosis. Complicated appendicitis has been associated with a significant risk of postoperative septic complications, including wound infections and intra-abdominal abscess formation. This study aimed to evaluate the types of complicated appendicitis and their relationship to patient's demographic data, postoperative course and the length of hospital stay in Al-Basra Teaching Hospital. Methods: This was a prospective clinical study involving patients with acute appendicitis admitted to Al-Basra Teaching Hospital from January 2017 to October 2019. The demographic data, types of complicated appendicitis, hospitalization duration, and postoperative complications were evaluated. The patients were divided into six groups according to age. All data were recorded and analyzed. Results: A total of 1210 patients, age from 6 to 69 years, mean age of patients was 23.45, males out-numbered females. Perforated appendicitis represents the main type of complicated appendicitis, and it was reported mostly among elderly patients. Patients with complicated appendicitis had a longer hospitalization and more postoperative complications than patients with non-complicated appendicitis. Conclusion: we concluded that nearly one third of the patients with acute appendicitis had complicated appendicitis, so they need a special pre and postoperative care and old age had non classical clinical picture with poor outcome.

Actualización en el manejo de fracturas abiertas: prevención de infección: utilidad de cultivos de herida: revisión bibliográfica / Update on the management of open fractures: infection prevention: utility of wound culture: bibliographic review / Atualização sobre o manejo de fraturas expostas: prevenção de infecções: utilidade das culturas de feridas: revisão bibliográfica

En las fracturas abierta una de las complicaciones más temidas por los cirujanos ortopédicos es la infección de partes blandas y ósea. A pesar de múltiples investigaciones, las pautas de manejo terapéutico para las fracturas abiertas continúan en constante cambio. El objetivo principal de nuestro trabajo fue realizar una actualización sobre la prevención de la infección en las fracturas abiertas a través de una búsqueda bibliográfica poniendo especial énfasis en la utilidad de los cultivos (recuento microbiano) de heridas en el perioperatorio de estas fracturas.

In open fractures, one of the most feared complications by orthopedic surgeons is soft tissue and bone infection. Despite multiple investigations, therapeutic management guidelines for open fractures, is constantly changing. The main objective of our work was to make an update on the prevention of infection in open fractures through a bibliographic search, with special emphasis on the usefulness of cultures (microbial count) of wounds in the perioperative period of these fractures.

Nas fraturas abertas, uma das complicações mais temidas pelos cirurgiões ortopédicos é a infecção de tecidos moles e ossos. Apesar de várias investigações, as diretrizes de tratamento terapêutico para fraturas expostas estão mudando constantemente. O principal objetivo do nosso trabalho foi atualizar a prevenção de infecção em fraturas expostas por meio de uma pesquisa bibliográfica, com ênfase especial na utilidade das culturas (contagem microbiana) de feridas no período perioperatório dessas fraturas.

Hidrogeis de polivinil-álcool (PVA) contendo o bacteriófago UFV-AREG1 para aplicação como curativo adesivo para a indústria de alimentos / Polyvinyl-alcohol (PVA) hydrogel containing the UFV-AREG1 bacteriophagus for application as a curative adhesive for the food industry

Infecções cutâneas obtidas por cortes nas mãos de manipuladores podem gerar contaminação nos alimentos. O objetivo deste trabalho foi incorporar o bacteriófago UFV-AREG1 em hidrogel de álcool poli(vinílico) – PVA, aplicando-o futuramente como curativo adesivo. Foi adicionado 1,0 mL de solução do fago no PVA e seco em estufa por 48 h. Após, os hidrogeis foram submetidos a testes de Intumescimento, Espectroscopia no infravermelho (FTIR) e efeito antimicrobiano sobre E. coli O157:H7. O intumescimento do PVA-fago foi maior que o PVA-controle (p<0,05). A área de inibição do PVA-fago foi de 3,715 cm2 contra 2,916 cm2 do controle. As análises do FTIR mostraram um pico para o PVA-fago não encontrado no PVA-controle. Foi possível incorporar o bacteriófago em hidrogel de PVA e avaliar sua liberação para posterior aplicação como curativo adesivo.

Implementação do processo de enfermagem no paciente queimado: um estudo de caso / Implementing the nursing process for a burn patient: a case study / Implementación del proceso de enfermería a paciente quemado: un estudio de caso

Objetivo: implementar o processo de Enfermagem (PE) no contexto do cuidado de um paciente queimado assistido em instituição pública de saúde. Método: estudo de caso, em que as Necessidades Humanas Básicas de Horta (1979) foram adotadas como referencial teórico. A implementação do PE pautou-se nas seguintes etapas: preenchimento do histórico e exame físico, elaboração dos Diagnósticos de Enfermagem (DE), planejamento, além de implementação das atividades definidas a partir das intervenções. Em seguida, foram realizadas avaliações sequenciais do paciente. Resultados: após análise dos indicadores clínicos, elencou-se como prioritários o padrão respiratório ineficaz, risco de infecção e integridade da pele prejudicada. Em seguida foi realizado o planejamento e definição das metas, intervenções e atividades a serem implementadas para posterior avaliação. Conclusão: a implementação do Processo de Enfermagem nos cuidados de um paciente queimado possibilita o desenvolvimento de uma assistência de qualidade, pautada no conhecimento científico.

Objective: to implement the nursing process (NP) in the context of care for a burn patient treated at a public health institution. Method: in this case study, the theoretical frame of reference was given by Horta's Basic Human Needs (1979). The NP was implemented in the following steps: completion of the case history and physical examination, preparation of Nursing Diagnoses (NDs), planning, and implementation of the activities recommended by the interventions. Sequential patient evaluations were then performed. Results: after analyzing the clinical indicators, the priorities were listed as ineffective respiratory pattern, risk of infection and impaired skin integrity. The goals, interventions and activities to be implemented for further evaluation were then planned and specified. Conclusion: implementation of the NP in care for burn patient made it possible to produce quality care guided by scientific knowledge.

Objetivo: implementar el Proceso de Enfermería (PE) en el contexto del cuidado de un paciente quemado asistido en institución pública de salud. Método: estudio de caso, en que las Necesidades Humanas Básicas de Wanda Horta (1979) se adoptaron como referencial teórico. La implementación del PE se basó en las siguientes etapas: llenado del historial y examen físico, elaboración de los Diagnósticos de Enfermería (DE), planificación, además de implementación de las actividades definidas a partir de las intervenciones. A continuación, se realizaron evaluaciones secuenciales del paciente. Resultados: después del análisis de los indicadores clínicos, se definió como prioritario el patrón respiratorio ineficaz, el riesgo de infección y la integridad de la piel perjudicada. A continuación se realizó la planificación y definición de las metas, intervenciones y actividades a ser implementadas para posterior evaluación. Conclusión: la implementación del Proceso de Enfermería en el cuidado de un paciente quemado posibilita el desarrollo de un cuidado de calidad, basado en el conocimiento científico.

Heridas por mordedura animal en la región maxilofacial: revisión de literatura y presentación de casos / Animal bite wounds in the maxillofacial region: a review of the literature and case reports

Las heridas por mordida en la región maxilofacial son relativamentecomunes y se consideran de tratamiento complejo; son contaminadas con una flora oral bacteriana única y, en ocasiones, tienen resultados estéticos devastadores. Las heridas pueden ser ocasionadas por animales domésticos, salvajes y humanos. El clínico debe tener una comprensión multidisciplinaria del manejo de las mismas, incluyendo el abordaje médico, quirúrgico, viral, bacteriológico y la secuencia propia del tratamiento. Se presenta una revisión de la literatura, así como casos clínicos para el tratamiento integral de este tipo de trauma.

Bite wounds in the maxillofacial region are relatively common and are regarded as diffi cult to treat given the associated contamination with what is a unique polymicrobial inoculum. The aesthetic consequences can occasionally prove devastating. The wounds can be caused by both domestic and wild animals, as well as by humans. Clinicians need to have a multidisciplinary understanding of how to manage such wounds, including surgical, medical, virological, and bacteriological aspects, and the proper sequence of treatment. We present a review of the literature and a number of clinical cases for the comprehensive management of this type of trauma.

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

Burn wound infection; significance of rule of nine in microbial surveillance

Burn injuries are common and major health problem throughout the world. The burn wound represents as a favorable area for opportunistic colonization of microorganisms with exogenous and endogenous origin. In burns patients infections arise from multiple sources. Burn wounds become initially colonized and infected with Gram positive bacteria, mainly Staphylococci, that are superseded during the second week by Gram Negative bacteria. it is a microbial surveillance retrospective study; that aimed to evaluate the significance of Rule of nine in diagnosis of aerobic bacterial burn wound infection and carried out in between June 2007 to September 2011 in the Department of Pharmaceutics, University of Karachi.Descriptive retrospective study. A total of 118 patient irrespective of age, sex, date and time of burn, date and time of hospital admission, interval between time of burn and hospital admission, degree and percentage [%] of burn and duration of hospital stay [when specimen collected] were registered for this study. All patients were divided into two groups [A and B]. Out of 58 patients of group A isolation rate per patient was 1.1 while in group B it becomes 3.0. According to TBSA the isolation rate in group B rises with rise in TBSA. Most prevalent organism in these patients was found S. aureus[23%] P.aeruginosa[21%]. Burn patients are incubator for variety of aerobic bacteria and rate of isolation of these organisms increase with rise in TBSA. The wounds of these patient must required continuous microbial surveillance that may reduce the rate of mortality

Indicador de qualidade assistencial úlcera por pressão: análise de prontuário e de notificação de incidente / Indicador de calidad úlcera por presión: análisis de los registros médicos y notificación de incidentes / Pressure ulcer care quality indicator: analysis of medical records and incident report

Estudo transversal, com objetivos de comparar os dados notificados em sistema de indicador de qualidade assistencial de úlcera por pressão (UP), com registros em evoluções de enfermagem nos prontuários dos pacientes, descrever o perfil clínico e os diagnósticos de enfermagem dos pacientes que desenvolveram UP grau II ou mais. Amostra de 188 pacientes em risco para UP, internados em unidades clínicas/cirúrgicas de um hospital universitário do sul do país. Dados coletados retrospectivamente em prontuário e sistema informatizado de indicador assistencial, analisados estatisticamente. Dos 188 pacientes, seis (3%) apresentaram notificação de UP grau II ou mais, entretanto, 19 (10%) tiveram registro nas evoluções de enfermagem, constatando-se subnotificação de dados. A maioria eram mulheres, idosos e portadores de doenças cerebrovasculares. O diagnóstico de enfermagem mais frequente foi Risco de infecção. Utilizar duas ou mais metodologias de pesquisa como dados de notificação de incidente e revisão retrospectiva em prontuário torna o resultado fidedigno.

Estudio transversal con el objetivo de comparar los datos reportados por el indicador de calidad de la atención de las úlceras por presión (UP) con de la evolución de enfermería; describir los diagnósticos clínicos y de enfermería de los que desarrollaron UP grado II o superior. La muestra fue 188 pacientes en riesgo de UP hospitalizado en unidades médicas/quirúrgicas. Los datos se recogieron retrospectivamente de los registros médicos y del sistema informatizado de indicadores, analizado estadísticamente. De los 188 pacientes, 6 (3%) notificados como UP de grado II o superior, 19 (10%) se registró en la evolución de la enfermera, constatándose subregistro de los datos. Las muestra eran compuestas por mujeres, ancianos, enfermedades cerebrovasculares. El diagnóstico de enfermería más frecuente fue Riesgo de la infección. El uso de dos métodos de investigación, como datos de notificación de incidente y revisión retrospectiva de registros médicos, hace con que los resultados sean fiables.

Cross-sectional study that aimed to compare the data reported in a system for the indication of pressure ulcer (PU) care quality, with the nursing evolution data available in the patients' medical records, and to describe the clinical profile and nursing diagnosis of those who developed PU grade 2 or higher. Sample consisted of 188 patients at risk for PU in clinical and surgical units. Data were collected retrospectively from medical records and a computerized system of care indicators and statistically analyzed. Of the 188 patients, 6 (3%) were reported for pressure ulcers grade 2 or higher; however, only 19 (10%) were recorded in the nursing evolution records, thus revealing the underreporting of data. Most patients were women, older adults and patients with cerebrovascular diseases. The most frequent nursing diagnosis was risk of infection. The use of two or more research methodologies such as incident reporting data and retrospective review of patients' records makes the results trustworthy.

Comparison the efficacy of cefazolin plus gentamicin with cefazolin plus ciprofloxacin in management of type -IIIA open fractures

The optimal antibiotic regimen is still controversial in open fractures. The purpose of this study was to evaluate the efficacy of two different antibiotic regimens in management of type III-A open fractures. From January 2001 to January 2008, patients with type IIIA open fractures admitted in Shahid Beheshti Hospital Affiliated to Babol University of Medical Sciences were enrolled. Patients randomly received cefazolin plus gentamicin [group I] or cefazolin plus ciprofloxacin [group II]. Both regimens were administered for 3 days. All patients were followed for 3 months. The efficacy of both regimens was compared. One hundred-forty eight and 153 patients were treated in group I and II, respectively. The mean age of the patients treated in group I was 36.96 +/- 14.4 and in group II was 36.93 +/- 13.51 years. The rate of deep infection in group I was 5.4% and in group II was 6.5%. The efficacy of regimen I was 94.6% and regimen II was 93.5%. Cefazolin plus gentamicin, or cefazolin plus ciprofloxacin both can be successfully used for prevention of infection in type IIIA open fractures

Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela / Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela

Objetivo Determinar la exposición laboral accidental a fluidos biológicos por contacto percutáneo en el personal Bioanalista de Laboratorios Clínicos públicos, sus factores asociados y el cumplimiento de medidas post exposición biológica. Métodos Se realizó un estudio descriptivo transversal, la muestra fue de 156 bioanalistas adscritos a laboratorios clínicos del área metropolitana del estado Zulia. Para la recolección de datos se aplicó un instrumento de escalas que exploró la exposición percutánea, los factores vinculados y el cumplimiento de medidas post exposición biológica. Resultados Se evidenció exposición por accidentes percutáneos, representados principalmente por pinchazos y cortaduras, detectados en razón de su ocurrencia en un nivel moderado (media entre 2-3,99). Como factores vinculados a la accidentabilidad percutánea, se registra la ocurrencia en nivel moderado con diversas agujas huecas, con sangre y hemoderivados, en manos y dedos, con una severidad superficial, en áreas de toma y procesamiento de muestras durante el re-encapuchado de objetos punzo cortantes. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposición. Existe relación entre la exposición percutánea con el nivel de cumplimiento detectado para el manejo post exposición p <0,001. Conclusión La magnitud y características de la exposición a fluidos biológicos detectada en este colectivo laboral reviste una problemática que puede impactar en la salud del personal y debe ser abordada institucionalmente para una efectiva gestión de prevención y control de riesgo.

Objective Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. Methods This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. Results There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. Conclusion The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

Single versus 3-dose antibiotic prophylaxis in clean and clean contaminated operations

Infection is a great problem in surgery and is encountered by all surgeons by nature of their craft; they invariably impair the first line of host defence. Bacteria may enter the wound during or after the operation and may be of endogenous or exogenous origin. The objective of this study was to determine the effectiveness of preoperative antibiotic prophylaxis in reduction of postoperative wound infection in clean and clean contaminated procedures and to compare the cost of antibiotic prophylaxis in both groups. This was a prospective study done on patients in General Surgery Department, Al-Noor Specialist Hospital, Holly Makkah, Saudi Arabia from 1[st] April 2006 to 30[th] March 2007. Total 400 patients were divided into 2 groups of 200 patients each: Group-A received single dose antibiotic prophylaxis, and Group-B received 3 doses of antibiotic therapy. Only clean and clean contaminated procedures were included and results were compared. In Group A, clean procedures [Group-A1] were 110, and clean contaminated [Group-A2] were 90 patients. In clean procedure, rate of infection was 5 out of 110 [4.54%] and in clean contaminated procedures it was 3 out of 90 [3.33%]. In Group B, in clean procedures [Group-B1], rate of infection was 7 out of 90 [7.77%], while in clean contaminated procedures [Group-B2] it was 9 out of 110 [8.18%] patients. Over all wound infection rate after single dose antibiotic prophylaxis was 4% in both procedures and 8% after 3-dose antibiotic therapy. Single dose antibiotic prophylaxis is as effective as 3-dose therapy in clean and clean contaminated procedures to prevent wound infection and is cost-effective

Tratamento de feridas crõnicas com coberturas oclusivas / Treatment of chronic wounds with occlusive dressings / Tratamiento de heridas crónicas con coberturas oclusivas

OBJETIVO: Analisar a microbiota de feridas crônicas de membros inferiores. MÉTODO: Este estudo prospectivo foi realizado entre os pacientes crônicos que tratavam de feridas em membros inferiores, de acordo com o protocolo que estabelecia o uso de coberturas interativas. Para a coleta de dados, foram realizadas duas culturas swab em dois momentos distintos: inicial, durante a primeira avaliação do paciente e, segundo, durante a 12ª troca de cobertura, aproximadamente, 45 dias após o início do tratamento. RESULTADOS: Todas as feridas tinham duas a quatro colônias simultaneamente e apresentaram alterações na sua microbiota durante o tratamento. Nenhum paciente desenvolveu infecção na ferida durante o estudo. CONCLUSÃO: Este estudo contribui para a compreensão do tema tratamento de ferida. Os resultados sugerem que o protocolo de tratamento utilizado promoveu alterações na microbiota favoráveis para a cicatrização de feridas. Compreender que mudanças ocorrem nas feridas durante um tratamento específico é importante para os cuidados de saúde, especialmente quando o tratamento se revelar eficiente e de baixo custo.

PURPOSE: This study aims to analyze the microbiota of chronic wounds in lower limbs. BASIC PROCEDURES: This prospective study was accomplished among patients who were in treatment for lower limbs chronic wounds according to a protocol which establishes the use of interactive dressings. Data collection and swab cultures were done in two different moments: first, during the patient's first assessment, and second, during the 12th dressing change, approximately 45 days after starting treatment. FINDINGS: All wounds had two to four colonies simultaneously and showed changes in their microbiota during the treatment. No patients developed wound infections during the study. CONCLUSIONS: This study contributes to the comprehension of wound topic treatment. Results suggest that the treatment protocol promotes changes in the microbiota which are favorable to the wound healing. It is important to healthcare providers to understand which changes occur in a wound during a specific treatment, especially when it proves to be efficient and low cost.

OBJETIVO: Analizar la microbiota de heridas crónicas de las extremidades inferiores. MÉTODO: Este estudio prospectivo se llevó a cabo entre los pacientes tratados con heridas crónicas en las piernas, según el protocolo que estableció el uso de apósitos interactivos. Para la recogida de datos fueron realizados dos cultivos swab en dos momentos: inicial, durante la primera evaluación del paciente y, segunda, durante el 12ª cambio de cobertura, aproximadamente 45 días después de iniciar el tratamiento. RESULTADOS: Todos los pacientes tenían de dos a cuatro colonias y presentaron alteración de la microbiota durante el tratamiento. Ningún paciente desarrolló infección en la herida durante el estudio. CONCLUSIONES: Este estudio contribuye a la comprensión de la cuestión del tratamiento de heridas. Los resultados sugieren que el protocolo de tratamiento utilizado promovió cambios favorables en la microbiota para la cicatrización de las heridas. Conocer qué cambios se producen en las heridas durante un tratamiento específico es importante para la atención de la salud, sobre todo cuando el tratamiento ha demostrado ser eficiente y de bajo costo.

[Single dose versus triple dose of antibiotic in prophylaxis of wound infection in acute appendicitis: prospective randomized study]

Wound infection is one of the most common problems in surgery and antibiotic usage is one of the ways to prevent it. This Study was performed for six months. All patients who were admitted for acute appendicitis in even days were given single dose of 500mg of metronidazole via IV route and all the patients who were admitted in the odd days were given single dose of 500mg metronidazole via IV route, plus two Separate doses of metronidazole in post operation period. There were 145 patient who were evaluated for this study with 115 male [%79.3] and 30 female [%20.7]. The first group [n=69] were received single dose of metronidazole where the second group [n=76] were received three doses of metronidazole. All patients had not any signs of wound infection. There weren't any meaningful statistical differences for prophylaxis of wound infection between single dose and multiple dose of antibiotic

Comparative evaluation of human placental extract for its healing potential in surgical wounds after orthopaedic surgery: an open, randomised, comparative study.

The study was conducted to compare the efficacy and safety of topical application of purified extract of human placenta (placentrex gel) versus povidone iodine for its wound healing potential after orthopaedic surgeries. In this open, comparative, randomised study, 79 patients above 18 years of age undergoing elective clean and uncontaminated orthopaedic surgery (open fracture reduction, spine surgery and debridement of wound) were enrolled in the study after obtaining written informed consent. Enrolled patients were randomised as per the PC generated randomisation chart (Rando 1.2, 2004) to receive either topical application of human placenta purified extract (PE) on the surgical wound or topical application of povidone iodine (PI) ointment on the surgical wound. Both preparations were applied topically on the surgical wound after the surgery, on days 3, 7 and on day 10, if required. Assessment of surgical wound was done after recovery from anaesthesia and on days 3, 7 and 10 based upon wound healing, physicians' global assessment of response to therapy (PGART) scale, pain and adverse effects. All 79 patients (40 PE and 39 PI) completed the study on day 10 as per the study protocol. Healing of the wound was observed in all patients. The number of patients reporting pain on days 3, 7 and 10 were similar in both PE and PI treatment (p, 0.527) groups. Wound induration was observed in 6 patients (15.00%) of PE and 15 (38.46%) of PI on day 7 (p, 0.041). None of the patients reported any side/adverse events during the study period. Purified placental extract and povidone iodine have comparative wound healing effects.

[ comparison of early excision and grafting V.S conventional therapy in patients with less than 20% burns]

For many years superficial partial thickness burns were treated conservatively. In full thickness burns, skin grafts were applied usually 3 to 8 weeks after injury. The goal of this study is to accomplish a comparison of early excision and grafting versus conventional therapy in small full thickness burns. This Clinical trial study enrold in 2004-2006 at Emam Reza Hospital of Mashhad University of Medical Sciences on 65 Female burned patients with total body surface less than 20%, This study was approved by the local committee of Medical Ethics. 28 patients were treated by early excision of second and third degree burned wounds to the level of fascia within first week of admission and wound immediately covered with autografts of partial thickness meshed 2:1. In 37 Patients of the conservative treatment group the burned wound was dressed daily and full thickness burns grafted after 3-4 weeks of injury. Individual characteristics was collected in questionnaire and analyzed by descrptive statistics. The mean age of patients was 33.4 Length of hospital stay in early excision and graft was 10 +/- 4 days and in conventional therapy 37 +/- 7 days, with significant difference. Mean number of produres in early excison and graft was one stage and in the other group was 1.24. Mortality in the two groups was similar. Small full-thickness burns, if treated by an experienced surgeon. can be safely early excised and grafted with a decrease in hospital stay, costs, and number of painful debridments and will have fewer infectious wound complications

Swab de feridas: recomendável? / Swab of wounds: is it advisable?

Cultura de feridas freqüentemente é utilizada para diagnosticar infecção e identificar o perfil de sensibilidade aos antimicrobianos. Diversos métodos de coleta de material microbiológico em feridas são descritos na literatura, entre eles o swab. Há consenso de que o swab é o mais utilizado, apesar de suscitar questionamentos. Este estudo tem como objetivo revisar a literatura sobre a aplicabilidade do swab em feridas, com finalidade de atualizar informações técnicas ao profissional de saúde. Com base em estudo de revisão de publicações, foi possível verificar as controvérsias e relacionar informações técnicas relevantes que possam nortear a utilização do swab.

Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds.

BACKGROUND: Acticoat (Smith & Nephew, Hull, UK) is a silver-coated dressing reported to reduce infection and exhibit antimicrobial activity in wounds. OBJECTIVE: The purpose of the present study was to compare the efficacy ofacticoat and 1% silver sulfadiazine (1% AgSD) for treatment of partial thickness burn wounds. MATERIAL AND METHOD: The authors reviewed 50 patients who had partial thickness burn wounds less than 25% admitted to Siriraj Burn Unit from May 2002 to September 2005. All patients were divided into 2 groups: the acticoat treated group (25 patients) and the 1% silver sulfadiazine treated group (25 patients). The 2 groups were compared for the etiology of burn wound, demographic data including age, sex, % Total Body Surface Area burn (TBSA%), cultured organisms, wound infection and outcome of Length Of hospital Stay (LOS) and level of pain. RESULTS: The authors found no significant differences in age, TBSA (%) between both groups. 7 patients (28%) developed wound infection. There were no differences in wound infection and LOS between both groups (p > 0.05). All of the patients who developed wound infection responded well to targeted topical and systemic antibiotic treatment. The 1% AgSD treated group (6 of 25, 24%) obtained more split thickness skin graft to close the granulation defects compared to patients who were treated with acticoat (4 of 25, 16%) but no statistical significance, p = 0.32). Average pain scores in the acticoat treated groups were significantly lower than the 1% AgSD treated group (4 +/- 0.6 versus 5 +/- 0.7, respectively). CONCLUSION: The present study confirms the efficacy of acticoat treatment in partial thickness burn wound. The authors conclude that acticoat has an advantage of limiting the frequency of replacement of the dressing and provides a less painful alternative to wound care with 1% AgSD with comparable incidence of burn wound infection. This is due to its long wear time and the ease of application and removal.

Recomendaciones para el manejo de mordeduras ocasionadas por animales / Guidelines for management of animal bites

Las mordeduras producidas por animales domésticos, silvestres o mascotas exóticas, son un problema que no está bien dimensionado en nuestro medio; sin embargo, representan un motivo de consulta frecuente. Se revisa la epidemiología, enfrentamiento inicial y recomendaciones para el manejo de mordeduras ocasionadas por perros y gatos; por la gran importancia que han ido adquiriendo en el último tiempo se revisan las mordeduras producidas por hámsters, ratones, conejos, hurones, perros de la pradera, simios, murciélagos, aves, iguanas y animales de granja.