ABSTRACT
OBJECTIVE: To examine how bacterial biofilms, as contributing factors in the delayed closure of chronic wounds in patients with diabetes, affect the healing process. METHOD: We used daily microscopic imaging and the IVIS Spectrum in vivo imaging system to monitor biofilm infections of bioluminescent Pseudomonas aeruginosa and evaluate healing in non-diabetic and streptozotocin-induced diabetic mice. RESULTS: Our studies determined that diabetes alone did not affect the rate of healing of full-depth murine back wounds compared with non-diabetic mice. The application of mature biofilms to the wounds significantly decreased the rate of healing compared with non-infected wounds for both non-diabetic as well as diabetic mice. Diabetic mice were also more severely affected by biofilms displaying elevated pus production, higher mortality rates and statistically significant increase in wound depth, granulation/fibrosis and biofilm presence. Introduction of a mutant Pseudomonas aeruginosa capable of producing high concentrations of cyclic di-GMP did not result in increased persistence in either diabetic or non-diabetic animals compared with the wild type strain. CONCLUSION: Understanding the interplay between diabetes and biofilms may lead to novel treatments and better clinical management of chronic wounds.
Subject(s)
Biofilms , Diabetes Mellitus, Experimental/physiopathology , Diabetes Mellitus, Type 1/physiopathology , Pseudomonas Infections/pathology , Wound Healing , Wound Infection/pathology , Animals , Male , Mice , Microorganisms, Genetically-Modified , Pseudomonas Infections/mortality , Pseudomonas Infections/physiopathology , Pseudomonas aeruginosa/genetics , Wound Infection/mortality , Wound Infection/physiopathologyABSTRACT
The notes of 30 terminally ill children with various diagnoses were searched for reports of symptoms that had occurred during their last month of life. All had stayed at Helen House, a hospice for children, for part or all of that time. The results were analysed for symptom frequency and resistance to treatment. Over four-fifths of the children were recorded as having pain in the last month of life. In a smaller number, symptoms such as muscle spasm and excessive secretions proved particularly difficult to control. The identification of symptoms in brain-damaged and young children, and the control of some of the more resistant symptoms, are discussed.
