Factors influencing dressing choice in wound care: a discussion.

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

Tularemia cases increase in the USA from 2011 through 2019.

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

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

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

Increasing Incidence of Spotted Fever Group Rickettsioses in the United States, 2010-2018.

Spotted fever group Rickettsia species are intracellular bacteria transmitted by tick or mite vectors and that cause human diseases referred to as spotted fever group rickettsioses, or spotted fevers. In the United States, the most recognized and commonly reported spotted fevers are Rocky Mountain spotted fever (RMSF) (Rickettsia rickettsii), Rickettsia parkeri rickettsiosis, Pacific Coast tick fever (Rickettsia species 364D), and rickettsialpox (Rickettsia akari). In this study, we summarize and evaluate surveillance data on spotted fever cases reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System from 2010 to 2018. During this period, there were 36,632 reported cases of spotted fevers with 95.83% (N = 35,104) reported as meeting the case definition as probable and 4.17% (N = 1528) reported as meeting the case definition as confirmed. The average national incidence of total cases, both probable and confirmed, was 12.77 cases per million persons per year. The highest statewide incidence was in Arkansas, with 256.84 per million per year, whereas the lowest incidence occurred in California, with 0.32 per million per year (note that spotted fevers were not notifiable in Hawaii and Alaska). Cases of spotted fevers were reported more frequently among males by gender, White by race, and non-Hispanic by ethnicity. The incidence of spotted fevers increased significantly from 2010 to 2018, but it is uncertain how many of the reported cases were RMSF and how many developed from more moderate spotted fevers. Improvement of the ability to differentiate between spotted fever group Rickettsia species is needed.

Complete Genome Sequence of Stenotrophomonas maltophilia Siphophage Summit.

Stenotrophomonas maltophilia is an opportunistic pathogen exhibiting resistance to multiple antimicrobials. This study reports the complete genome of an S. maltophilia siphophage, Summit. Its genome of 95,728 bp has 148 protein-coding genes and 5 tRNAs, including 1 predicted suppressor tRNA. Possible target genes for the suppressor tRNA are not identified.

Patient knowledge and experience of hyperbaric oxygen treatment.

INTRODUCTION: This paper presents a quantitative and qualitative study exploring patients' knowledge and experience of hyperbaric oxygen treatment (HBOT). METHODS: Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations: Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description. RESULTS: Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of the HBOT course, anxiety was reduced. The interview data revealed themes based around the physical, emotional and social aspects of HBOT: (1) anxiety within self; (2) naivety to normalisation; (3) enjoyment being a 'diver'; and (4) burdens of HBOT. CONCLUSIONS: Many patients experienced anxiety prior to commencing HBOT but, with support, quickly adjusted to treatment, transitioning from a state of naivety to normalisation in their experience of the hyperbaric chamber. They enjoyed feeling like a 'diver' and considered aspects of the burdens of treatment, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT.

Wound assessment and dressing selection: an overview.

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

Using Data Surveillance to Understand the Rising Incidence of Babesiosis in the United States, 2011-2018.

Babesiosis is a tick-borne disease that is caused by intraerythrocytic protozoan parasites of the genus Babesia. Common symptoms of babesiosis are generally characterized as nonspecific flu-like symptoms, such as fever or chills. Human infections are reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System (NNDSS). This study summarizes data of Babesia infections reported to the CDC by the NNDSS from 2011 to 2018. In total, there were 14,159 reported cases of babesiosis, and the incidence rate was 5.55 cases per million persons per year, displaying an increasing trend during the study period. The demographic group most affected was middle-aged and elderly white males. Infections were most abundant in the New England and the Mid-Atlantic regions of the United States. Our study provides useful results for a basic understanding of incidence, spatial and temporal distribution, and severity of babesiosis.

Arthroscopic Debridement of Intrapelvic Abscess With Coexistent Septic Hip in an Adult Female: A Technical Note.

The aim of this study was to describe the technique for debridement of an intrapelvic abscess through an arthroscopic approach. We present a 24-year-old female with an obturator internus muscle abscess that extended across the obturator membrane and into the hip joint. Decompression of the intrapelvic abscess through hip arthroscopy was planned after close examination of preoperative images. Intrapelvic space was safely accessed by hip arthroscopy. The patient was asymptomatic and had normalized biomarkers at 6 months; however, the abscess recurred at 1 year postoperation. Details of the technique for intrapelvic access and anatomic structures at risk are described in this study.

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

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

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

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

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

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

Interaction of severe acute respiratory syndrome-coronavirus and NL63 coronavirus spike proteins with angiotensin converting enzyme-2.

Although in different groups, the coronaviruses severe acute respiratory syndrome-coronavirus (SARS-CoV) and NL63 use the same receptor, angiotensin converting enzyme (ACE)-2, for entry into the host cell. Despite this common receptor, the consequence of entry is very different; severe respiratory distress in the case of SARS-CoV but frequently only a mild respiratory infection for NL63. Using a wholly recombinant system, we have investigated the ability of each virus receptor-binding protein, spike or S protein, to bind to ACE-2 in solution and on the cell surface. In both assays, we find that the NL63 S protein has a weaker interaction with ACE-2 than the SARS-CoV S protein, particularly in solution binding, but the residues required for contact are similar. We also confirm that the ACE-2-binding site of NL63 S lies between residues 190 and 739. A lower-affinity interaction with ACE-2 might partly explain the different pathological consequences of infection by SARS-CoV and NL63.

Reintroduction of the 2G12 epitope in an HIV-1 clade C gp120.

Many clade C isolates of HIV-1 do not react with monoclonal antibody (MAb) 2G12, a broad-ranging human neutralizing MAb that recognizes high mannose carbohydrate groups attached to glycoprotein gp120. We reintroduced a partial and complete 2G12 epitope into a clade C background, HIV-1(CN54), and examined the antibody reactivity of the resulting recombinant molecules. Two glycosylation sites recovered 2G12 binding completely, but some binding was evident after the reintroduction of a single glycosylation site at Asn295.

CesT is a bivalent enteropathogenic Escherichia coli chaperone required for translocation of both Tir and Map.

Map is an enteropathogenic Escherichia coli (EPEC) protein that is translocated into eukaryotic cells by a type III secretion system. Although not required for the induction of attaching and effacing (A/E) lesion formation characteristic of EPEC infection, translocated Map is suggested to disrupt mitochondrial membrane potential, which may impact upon subsequent functions of the organelle such as control of cell death. Before secretion, many effector proteins are maintained in the bacterial cytosol by association with a specific chaperone. In EPEC, chaperones have been identified for the effector proteins translocated intimin receptor (Tir) and EspF, and for the translocator proteins EspB and EspD. In this study, we present evidence that the Tir-specific chaperone, CesT, also performs a chaperone function for Map. Using a combination of biochemical approaches, we demonstrate specific interaction between CesT and Map. Similar to other chaperone-effector pairings, binding is apparent at the amino-terminus of Map and is indicated to proceed by a similar mechanism to CesT:Tir interaction. Map secretion from a cesT mutant strain (SE884) is shown to be reduced and, importantly, its translocation from this strain after infection of HEp-2 cells is almost totally abrogated. Although other chaperones are reported to have a bivalent binding specificity, CesT is the first member of its family that chaperones more than one protein for translocation.