Disminución de la necesidad de cobertura con injertos y baja tasa de cicatrización hipertrófica en quemaduras tras desbridamiento enzimático / Reduced need for grafting and low incidence of hypertrophic scarring in burns after enzymatic debridement

Introducción y Objetivo. El tratamiento clásico de las quemaduras se basa en la eliminación precoz de la escara; sin embargo, el desbridamiento tangencial de las quemaduras mixtas y profundas retira tejidos dérmicos viables, obligando a la cobertura con autoinjertos. El desbridamiento enzimático con enzimas proteolíticos enriquecidos con Bromelaína (Nexobrid®) mantiene restos dérmicos que pueden permitir la reepitelización por sí misma de la quemadura. Evaluamos el uso en nuestra unidad de Nexobrid® (MediWound Ltd., Israel) en quemaduras mixtas y dérmicas profundas, valorando la capacidad de reepitelización tras su uso, la tasa de injerto en los pacientes tratados, y la aparición de cicatrización hipertrófica. Pacientes y Método. Evaluamos retrospectivamente 36 pacientes tratados con Nexobrid® entre enero de 2015 y febrero de 2016, 11 mujeres y 25 varones con una media de edad de 42.89 años. La superficie corporal quemada media fue del 7.47% y la diagnosticada como profunda del 6.42%.Todos los pacientes presentaron quemaduras profundas con necesidad de cirugía para su desbridamiento y cobertura con injertos. Resultados. Tras el desbridamiento enzimático solo el 36.1% de los pacientes (13 de 36) requirió cobertura con injertos (p < 0.001).La superficie injertada fue tan solo del 2.67% frente al 4.98% que fue desbridada enzimáticamente (p < 0.001). A pesar de que el tiempo hasta la epitelización total de las quemaduras se alargó hasta los 25.69 días, tan solo un 11.1% de los pacientes desarrolló cicatriz hipertrófica. Conclusiones. Nexobrid® permite el desbridamiento completo de las quemaduras mixtas y dérmicas profundas disminuyendo el porcentaje de pacientes que requieren autoinjertos y la superficie injertada, con bajas tasas de cicatrización hipertrófica (AU)

Background and Objective. Early burn scar removal is the standard of care for burn patients; excisional debridement, however, often leads to excision of dermal remnants, making autografting unavoidable. Enzymatic debridement with proteolytic enzymes enriched in Bromelain (Nexobrid®) leaves these dermal remnants to allow spontaneous healing of partial thickness burns. This study evaluates if Nexobrid® (MediWound Ltd., Israel) reduces the need for surgery and autografting in intermediate and deepdermal burns, the reduction in the excised and grafted area, and the development of hypertrophic scarring. Patients and Methods. We conduct a prospective study between January 2015 and February 2016 evaluating 36 patients (11 females, 25 males) whose mean age was 42.89, with burns covering a mean of 7.47% of their total body surface area (6.42% deep burns). All patients would need excision and autografting as their previous standard of care. Results. After enzymatic debridement, only 13 patients (36.1%) needed surgery (p < 0.001). The area of burns excised and grafted was reduced (2.67% vs. 4.98% p < 0.001). Since wound closure was delayed until 25.69 days, only 11.1% of the patients developed hypertrophic scars. Conclusions. Nexobrid® allows scar removal in deep-dermal and intermediate burns, reducing the need of surgery and the grafted body surface area, while achieving good scars (AU)

Expresión anticipada de voluntades: actitud y conocimiento de los ciudadanos / Living wills: Knowledge and attitudes of the public

Objetivos: Describir los conocimientos y las actitudes de los ciudadanos acerca del documento de expresión anticipada de voluntades en la ciudad de Cáceres (España) y comparar las diferentes actitudes entre los ciudadanos que tenían y no tenían conocimientos, así como la importancia de la implicación de los profesionales sanitarios en la información. Método: Diseño: Estudio descriptivo transversal, con entrevista personal mediante cuestionario validado dirigido por personal entrenado. Emplazamiento: la ciudad de Cáceres (90.752 habitantes). Participantes: 382 ciudadanos mayores de 18 años residentes en Cáceres. Los criterios de exclusión fueron que no aceptaran participar en la encuesta y aquellos que no tuvieran condiciones psíquicas adecuadas para participar. Mediciones principales: variables sociodemográficas y de conocimientos y actitudes de los ciudadanos. Resultados: Se cumplimentaron 382 (100% del tamaño muestral) cuestionarios, siendo el 51,8%mujeres y el 48,2% hombres, con una edad media de 44,77 (18-97) años. El 23,3% de los encuestados sí tenía conocimiento sobre el documento de voluntades anticipadas y el 76,7% no lotenía. Al comparar las variables sobre las actitudes ante el documento entre los dos grupos se encontraron diferencias estadísticamente significativas. Conclusiones: Hay un gran desconocimiento acerca de este tema en la población del presente estudio, y existen diferencias significativas de las actitudes de los ciudadanos ante el documento entre los que ya tienen conocimiento y los que no. De ahí la importancia de los profesionales sanitarios en el proceso de información a los pacientes (AU)

Objective: To determine the attitudes and knowledge of the living wills document among the public in the city of Caceres, Spain, and to compare the different attitudes between those knew about it and those who did not, as well as the importance of the involvement of health professionals in this information. Method: Design: Descriptive study using questionnaires with validated personal interview conducted by trained personnel. Location: Cáceres city. Participants: 382 people over 18 years-old living in Cáceres. The exclusion criteria were not to agree to participate in the survey and those who did not have adequate mental ability to participate. Measurements: demographic variables and knowledge and attitudes of the public. Results: We completed 382 (100% sample size) questionnaires, 51.8% women and 48.2% males, and a mean age of 44.77 years (18-97). Less than a quarter (23.3%) of respondents knew about living wills and 76.7% did not. Comparing the variables on attitudes to the paper between the two groups were statistically significant differences. Conclusions: There is a lack of knowledge about this subject in the study population, and there are significant differences in the attitudes of the public about the document among those who already knew about it and those who do not, hence the importance of health professionals in the process of patient information (AU)

Update on the treatment of chronic kidney disease-mineral and bone disorder.

Chronic kidney disease (CKD) is associated with increased morbidity and mortality. Mineral metabolism disturbances appear to contribute to the high mortality rate. A CKD-mineral bone disorder (CKD-MBD) has recently been defined as a systemic disorder manifested by one or a combination of abnormalities in bone biopsy, laboratory parameters and/or vascular or other soft-tissue calcifications. New available treatments have contributed to move from the former treatment paradigm of renal osteodystrophy to CKD-MBD management, beyond mere control of parathyroid hormone (PTH) and trying to improve cardiovascular or survival outcomes. Thus, the recommended multidisciplinary approach among nurses, dieticians and clinicians, helping not only through dietary assessment but also through education, behaviour control and by increasing the patient's personal motivation, may have additional important benefits. This article will review the current therapeutic approach with phosphate binders including the latest developments, vitamin D derivatives and selective vitamin D receptor activators as well as the new calcimimetics, all used in the treatment of this systemic disease.

Non-invasive and non-destructive micro-XRF and micro-Raman analysis of a decorative wallpaper from the beginning of the 19th century.

Non-destructive and non-invasive micro-Raman fibre optic and micro-XRF analyses were performed to study a wallpaper from the beginning of the 19th century. The complementarity of these two non-destructive techniques is shown in this work. The analysed artwork is considered one of the most beautiful wallpapers ever manufactured according to the catalogues and books; it is known as Chasse de Compiègne, manufactured by Jacquemart, Paris, in 1812. During the analysis, an unexpected pigment was detected by both analytical techniques: lead-tin yellow type II. This pigment was used until ca. 1750, when other yellow pigments replaced it, thus it is very difficult to find it in paintings afterwards. Together with this pigment, red lead, Prussian blue, brochantite, yellow iron oxide, calcium carbonate, vermilion, carbon black of animal origin (bone black), lead white, and raw and burnt sienna were also determined by combining the analytical information provided by both techniques. A possible degradation of brochantite to antlerite is also discussed.

Investigation of degradation mechanisms by portable Raman spectroscopy and thermodynamic speciation: the wall painting of Santa María de Lemoniz (Basque Country, North of Spain).

This article presents the "in situ" and totally non destructive investigation of a wall painting in Santa María de Lemoniz (Biscay, Basque Country, Spain) by Raman microprobe spectroscopy 14 years after its restoration. Although no sample was allowed to be taken, it has been possible to determine the original pigments in the artwork (vermilion, red iron oxide, yellow iron oxide, carbon black, lead white), as well as some degradation products (calcium oxalate dihydrate, anhydrite). For the first time, the mechanism for the transformation of malachite into copper basic sulphates has been ascertained by the integration of Raman data with thermodynamic speciation studies. Moreover, some remarks regarding the unsuitability of the past intervention procedure with regard to the chemical stability of the artwork are made.

Interaction between hemoglobin and glutathione in the regulation of blood flow in normal and septic pigs.

BACKGROUND: Hemoglobin (Hb) induces vasoconstriction by heme group binding nitric oxide in an irreversible fashion. Recent in vitro studies indicate that the thiol groups in Hb reversibly bind nitric oxide and participate in trans-nitrosylation reactions with other thiols. Sepsis is a pathophysiologic state characterized by vasodilation mediated, at least in part, by an excessive release of nitric oxide. The role of nitrosothiols (RSNOs) in these changes is unknown. OBJECTIVES: We tested the following in a porcine model of sepsis: (i) whether glutathione (GSH) reverses the hemodynamic effects of Hb; (ii) whether GSH induces an increase in blood flow in sepsis; (iii) whether RSNO plasma concentration increases in sepsis and is related to hypotension. DESIGN: Nonrandomized animal controlled study. SETTING: Animal research facility in a university hospital. SUBJECTS: Anesthetized pigs were monitored with a pulmonary artery catheter and ultrasonic blood flow probes in the mesenteric artery and the portal vein for measurement of systemic, mesenteric, and portal blood flows (Q(TOT), Q(MES), and Q(POR), respectively). Four groups of pigs were studied: nonseptic, septic, nonseptic treated with Hb (stroma-free purified porcine hemoglobin), and septic treated with Hb (n = 6 in each group). INTERVENTIONS: Sepsis was induced at 0 min by the administration of live Escherichia coli. Hb (400 mg/kg/hr) was administered at 240 mins, followed by glutathione (1 g iv). MEASUREMENTS AND MAIN RESULTS: Hb induced a pressor response and a decrease in Q(TOT), Q(MES), and Q(POR). Glutathione reversed the effects of Hb on Q(MES) and Q(POR). In septic pigs not treated with Hb, GSH induced an increase in Q(POR). RSNO plasma concentration increased after the induction of sepsis and correlated significantly with blood pressure. CONCLUSIONS: These results indicate the reversibility of the effects of Hb by GSH, probably by interactions between nitric oxide and the reduced sulfhydryl groups in Hb, and suggest a role of RSNOs in the cardiovascular changes of sepsis.