Severe Retroperitoneal Hemorrhage in a COVID-19 Patient on a Therapeutic Dose of Low Molecular Weight Heparin: A Case Report.

Extensive drug treatment for coronavirus disease 2019 (COVID-19) includes low molecular weight heparin (LMWH). At therapeutic doses of LMWH, there is an increased risk of bleeding complications. Spontaneous, non-traumatic bleeding into the retroperitoneum is a life-threatening condition that can progress very rapidly. We describe a complication of COVID-19 bronchopneumonia treatment in which a patient developed a shock condition caused by non-traumatic bleeding into the retroperitoneum and abdominal wall due to LMWH overdose. The patient was operated on under difficult conditions - in biosafety level 3 (BSL-3). This case is exceptionally fascinating and informative. Nowadays, it is essential to point out possible complications associated with the treatment of COVID-19. Based on this report, we emphasize the need for careful LMWH dosing and quick and accurate diagnosis. Surgeons should maintain a higher index of suspicion for spontaneous bleeding in non-specific abdominal pain patients with COVID-19 or patients receiving therapeutic doses of LMWH.

Deep frozen amniotic membrane used as a scaffold and/or carrier for different cell types.

Amniotic membrane is a biological material widely used in plastic and reconstructive surgery and in ophthalmology. Due to its excellent biocompatibility and strength we tried to use it as a scaffold for the in vitro cultivation of different cell types, especially keratinocytes and limbal stem cells. It was possible to cultivate limbal stem cells and keratinocytes without using 3T3 mouse fibroblast feeder cells on deep frozen amniotic membranes. The amniotic membrane can also be used as a carrier for suspensions of different types of cells, allowing a substantial reduction of the cultivation time needed to prepare cell cultures for clinical application to burn patients. Our results show that the amniotic membrane seems not only to be an excellent carrier for human keratinocytes and corneal limbal stem cells, but also for other cell types, including dermal fibroblasts, adipose tissue-derived mesenchymal stem cells and chondrocytes.

Clinical Experience With the Use of Negative Pressure Wound Therapy Combined With a Silver-impregnated Dressing in Mixed Wounds: A Retrospective Study of 50 Cases.

UNLABELLED: Although negative pressure wound therapy (NPWT) has been used for more than 20 years, as far as the authors are aware, there is little research aimed at the evaluation of the combination of NPWT with a silver-impregnated dressing. OBJECTIVE: The aim of this study was to examine the effect, efficacy, and safety of NPWT in conjunction with a silver-impregnated dressing. MATERIALS AND METHODS: The authors used a retrospective study of 54 acute and chronic wounds treated in 50 patients over a 2-year period. Demographic data, wound characterizations, wound cultures before and after NPWT, the duration of NPWT and number of sponge changes for each patient, the types of surgical procedures used for wound closure following NPWT, and the healing time and length of hospital stays were recorded. RESULTS: In 26 wounds, deep structures (ie, bones and tendons) were exposed. The mean NPWT duration was 9.2 days. Mean healing time was 16 days. There was a statistically significant decrease in the pathogenic microbial strains after NPWT treatment combined with the silver-impregnated dressing (paired t test; P = 0.0038). The shift from complicated to easier surgical wound-closure procedures was observed. DISCUSSION: According to all results obtained, described, and discussed, the authors consider the use of a nonadherent silver-impregnated dressing in conjunction with NPWT to be beneficial and efficacious. No adverse events or reactions related to the silver-impregnated contact layer used during NPWT have been observed in the patients, which confirmed the safety of this method.

In vitro efficacy of various topical antimicrobial agents in different time periods from contamination to application against 6 multidrug-resistant bacterial strains isolated from burn patients.

AIM: In vitro efficacy evaluation of eleven topical antimicrobials against multidrug-resistant (MDR) bacteria isolated from burn wounds of our patients. MATERIAL AND METHODS: Growth of six MDR bacterial strains: Pseudomonas aeruginosa (2 strains), Staphylococcus aureus, Staphylococcus haemolyticus, Enterococcus faecalis and Escherichia coli in burn-wound models was evaluated 24-h after application of the tested agents. Four different wound models were created to investigate the role of time elapsed between inoculation of bacteria and application of the agents on their antimicrobial activity and efficacy. RESULTS: The efficacy against all the 6 bacteria in freshly contaminated wounds was excellent in majority of the tested agents. The longer was the time interval between inoculation and application of the topical antimicrobial agents, the higher failure of the agents was observed. CONCLUSIONS: Topical antimicrobials play an important role in treatment of burn wounds, but they should be used according to their efficacy against bacterial strains present in patients' wounds. In cases where topical agents have been applied after 24 h, when formation of mature biofilm in the wound could be expected, it would probably not be possible to kill all the bacteria using topical antimicrobial therapy only.