rhEGF-Loaded Hydrogel in the Treatment of Chronic Wounds in Patients with Diabetes: Clinical Cases.

The aim of the study was to evaluate the healing process of chronic wounds treated with carboxymethylcellulose loaded with recombinant human epidermal growth factor in patients with diabetes. The case series consisted of 10 patients treated at the university hospital for 12 weeks. Data were analyzed using SPSS version 22.0. according to the intention to treat the principle, without the loss or exclusion of the participants. The sample consisted of 70% (7/10) males with a mean age of 61.9 years (±9.4); all (100%) had diabetes mellitus and 70% (7/10) had systolic hypertension associated with diabetes mellitus. Sixty percent (6/10) presented lesions of diabetic etiology and 40% (4/10) presented lesions of venous etiology; 70% (7/10) had had lesions for less than 5 years. The mean glycated hemoglobin was 7.8% (±2.7%), while the mean ankle-arm index (AAI) was 0.94 (±0.21). The mean initial area of all wounds was 13.4 cm², and the mean final area was 7.8 cm2, with a reduction rate of 28.9% over the 12 weeks of treatment. The reduction rate of diabetic ulcers was higher (33.4%) than that of venous ulcers (22.1%). Regarding the type of tissue, there was an increase in granulation and epithelialization, and a decrease in slough and the amount of exudate that were statistically significant (p = 0.021). No participant had severe or local adverse events during the study period. Epidermal growth factor was effective in the treatment of chronic wounds, especially diabetic ulcers, resulting in the reduction of the wound area and the improvement of tissue and exudate quality.

Effectiveness of a synthetic human recombinant epidermal growth factor in diabetic patients wound healing: Pilot, double-blind, randomized clinical controlled trial.

To investigate whether the addition of human recombinant epidermal growth factor (h-EGF) to 2% carboxymethyl cellulose gel is more effective in diabetic wound healing than standard treatment, a pilot, double-blind, randomized and controlled clinical trial with therapeutic intervention was performed at a university hospital. The sample consisted of 25 patients (14 in the intervention group that used rh-EGF and 11 in the control group that used 2% carboxymethyl cellulose gel). Data were tabulated in SPSS and analysed by intention to treat, without loss or exclusion of participants. Twenty-five subjects participated with a mean age of 60.6 years, a predominance of males in both groups and 100% prevalence of type-2 diabetes. Within 12 weeks, complete wound healing occurred in three ulcers in the intervention group versus one ulcer in the control group. The percent reduction in the wound area was significantly higher in the intervention group than in the control group (p = 0.049). Concerning the types of tissue, an increase in granulation and epithelial tissue and a reduction in exudate levels were observed in both groups. Decreased slough occurred only in the intervention group. No participant experienced serious or local adverse events during the study period. This study shows that h-EGF is effective, with a statistically significant reduction in wound area, improvement of tissue quality, and safe treatment of chronic wounds. In addition, this study demonstrated that blinding of participants during research using h-EGF is feasible.

Blood Cell Count and the Presence or Absence of Infection in Venous Ulcers Treated With Platelet-Rich Plasma.

INTRODUCTION: In general, chronic wounds are colonized by bacteria; however, when microorganisms start to multiply at higher levels, wounds can become infected, causing prolongation of the inflammatory phase and retardation of collagen synthesis and epithelialization. OBJECTIVE: The objective of this study was to evaluate the presence of infection in venous ulcers after 12 weeks of treatment with autologous platelet-rich plasma (PRP) and determine global white blood cell counts. MATERIALS AND METHODS: This case series study involved a sequential sample of 17 patients with venous ulcers treated with PRP for 12 weeks. Descriptive and inferential statistical analysis was performed using the McNemar test and χ² test. RESULTS: At baseline, 10 patients (58.8%) had wound infection. During the sixth week of treatment with PRP, only 3 patients (17.6%) continued to exhibit wound infection. After 12 weeks of PRP treatment, only 1 patient (5.9%) continued to exhibit wound infection. McNemar and χ² tests used to assess the presence of infection in the intervention group produced a P value of .0039 for a comparison of baseline and week 6 and a P value of .0078 for a comparison of baseline and week 12. These results demonstrated significant differences from baseline at both 6 weeks and 12 weeks of treatment, with greater significance at 12 weeks. There was no relationship between global white blood cell count and the presence of infection. CONCLUSION: After intervention with PRP, 94% of patients experienced improvement concerning the infection of ulcers.

Ciprofloxacin-Resistant Kerstersia gyiorum Isolated From a Chronic Wound in Brazil: A Case Report.

The presence of Kerstersia gyiorum in lower leg wounds has been reported in case studies from several countries. OBJECTIVE: This study evaluated the antimicrobial susceptibility profile of K gyiorum isolated from a chronic wound. METHODS: An 85-year-old woman with chronic venous insufficiency presented to an intermediate care unit in Niteroi City, Rio de Janeiro, Brazil, with an instep chronic wound of 14 cm² with wound duration of 6 months. K gyiorum was identified by matrix-assisted laser desorption ionization-time of flight, confirmed by 16S rRNA partial sequence analysis, and classified as resistant for ciprofloxacin by reagent strips(minimum inhibitory concentration [MIC] = 32 µg/mL) and the broth macrodilution method (MIC = 8 µg/mL). Intermediate resistance for ciprofloxacin was verified by microscan (MIC = 2 µg/mL). CONCLUSION: The authors identified the first, to their knowledge, lower leg wound with K gyiorum in Brazil and verified that it was ciprofloxacin resistant.

Monitoring and Molecular Characterization of Staphylococcus aureus Isolated from Chronic Wounds.

OBJECTIVE: Researchers analyzed chronic wounds treated with 2% hydrogel to determine whether the presence of methicillin-resistant Staphylococcus aureus (MRSA) is related to the presence of clinical signs of infection. METHODS: Thirty-five patients were recruited for this descriptive study using a quantitative approach. Staphylococcus aureus was identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Antibiotic susceptibility was determined using a disk diffusion test according to Clinical and Laboratory Standards Institute standards. Polymerase chain reaction, pulsed-field gel electrophoresis, and multilocus sequence typing were performed. Statistical analyses were performed using Spearman correlation coefficients for the variables MRSA and clinical signs of infection. MAIN OUTCOME MEASURES: The identification of MRSA or methicillin-sensitive S aureus (MSSA), presence or absence of an infection in the wound, and molecular characterization of bacteria were measured. MAIN RESULTS: Of the 35 patients analyzed, 8 (22.9%) were classified as having an infection in their wounds. Spearman ρ indicated a strong positive correlation between the increase in the number of clinical signs of infection and MSSA (P =.84), but only a moderate positive correlation with MRSA (P =.60). The S aureus clonal pattern was unique for each of the major bacteria isolated. Global MRSA sequence-type clones (ST-1 and ST-72) were detected in 2 patients. CONCLUSIONS: Compared with those colonized by MSSA, chronic wounds colonized by MRSA did not display a strong correlation with the presence of a greater number of clinical signs of infection.

Prevalence, Antimicrobial Susceptibility, and Clonal Diversity of Pseudomonas aeruginosa in Chronic Wounds.

PURPOSE: Our purposes in this study were to (1) identify Pseudomonas aeruginosa strains collected from swabs of chronic wounds, (2) evaluate the susceptibility of P. aeruginosa strains to various antimicrobials, (3) detect the presence of virulence factors exoenzyme S (exoS) and exoenzyme U (exoU) in P. aeruginosa strains, and (4) evaluate wound colonization by P. aeruginosa via pulsed-field gel electrophoresis (PFGE). DESIGN: Descriptive research using a quantitative approach. SAMPLE AND SETTING: Swabs from 43 adults with chronic wounds treated in an outpatient setting in Niterói City, Brazil, were included using convenience sampling. METHODS: Swabs were collected at 2 points during treatment, 30 to 45 days apart. P. aeruginosa isolates were identified using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Antimicrobial susceptibility testing was performed using the disk diffusion method. The presence of exoS and exoU genes was evaluated using polymerase chain reaction. Genotyping diversity was determined through PFGE. RESULTS: Forty-eight P. aeruginosa isolates were detected in chronic wounds, and 3 were multidrug resistant (6%). Resistance to aztreonam and ciprofloxacin was observed in 48% and 27% of isolates, respectively. The presence of the exoS gene was verified in 54% of isolates, and 27% were positive for the exoU gene. In most wounds, P. aeruginosa strains had the same genetic characteristics at the 2 time points analyzed, indicating that the wound beds remained colonized. CONCLUSIONS: P. aeruginosa was present in 75% of tested chronic wound samples, and the same clones persisted for more than 1 month. In addition, most bacteria contained virulence genes that were associated with high potential to establish infection. The use of silver in chronic wounds may be associated with multidrug resistance in P. aeruginosa; therefore, it is important to avoid colonization by these bacteria.

High prevalence of skin and wound care of hospitalized elderly in Brazil: a prospective observational study.

BACKGROUND: Skin changes caused by aging increase the risk of skin damages, such as pressure ulcers, during hospitalization of elderly patients. There is few information about the cost of wound treatment in Brazil. Conversely, skin and wound problems are highly reported among hospitalized elderly patients and caregivers. The purpose is to analyze the socio-demographic and clinical profile associated with skin and wound care in hospitalized elderly. METHODS: This is a prospective observational study. The sample consisted of 75 patients, aged 60 years or more, randomly selected in three hospitals in Rio de Janeiro, Brazil. Data extraction from nursing records of the sample, using cross mapping with Nursing Interventions Classification. Data Synthesis supported by SAS 6.11 (SAS Institute, Inc. Cary North Carolina) in association with SPSS version 14.0 and statistics analysis. RESULTS: The findings were: age standard deviation 7.8, with minimum as 60, and maximum as 91 years old. Prevalence of women and married seniors. High prevalence of long-term hospitalization. There were 21 Nursing Interventions in the nursing records and seventeen of them related to skin and wound care. They were described in 57 nursing activities, present during 376 evaluations and repeated 1756 times. A significant difference was obtained between age and the presence of the nursing interventions "Positioning" (p-0.004), Eye Care/Hygiene (p- < 0.0001) and Oral Health Maintenance (p-0.0003). CONCLUSION: The skin care to prevention and treatment of skin damages represented the major demand of nursing interventions in different clinical conditions of hospitalized elderly.

Terapia compresiva para el tratamiento de úlceras venosas: una revisión sistemática de la literatura / Terapia compressiva para o tratamento de úlceras venosas: uma revisão sistemática da literatura / Compression therapy for venous leg ulcers: a systematic review of the literature

Objetivo: Identificar artículos indexados que tienen que ver con el uso de la terapia de compresión elástica o inelástica como propuesta terapéutica para los pacientes con úlceras venosas. Métodos: Revisión sistemática de búsqueda bibliográfica en las bases de datos electrónicas Medline / Pubmed; Medline y Journals @ Ovid / Ovidio; CINAHL; Lilas y Cochrane, las estrategias de búsqueda utilizan los siguientes descriptores y palabras clave: leg ulcer; varicose ulcer; bandage; 'stockings, compression'; venous ulceration; venous ulcer; compressive therapy; compression therapy; stocking. Resultados: La búsqueda arrojó 25 artículos. El uso del vendaje con compresión fue más eficaz que el vendaje sin compresión. Los vendajes multicapa contribuyen a la curación de las úlceras venosas. El uso de medias de compresión y la cirugía correctora del flujo sanguíneo están asociados con la prevención de la recurrencia de las úlceras. Conclusión: El tratamiento de las úlceras venosas utilizando algún tipo de compresión fue eficaz en el proceso de curación (AU)

Objetivo: Identificar artigos indexados que tratam do uso da terapia compressiva elástica ou inelástica. Método: Revisão sistemática de literatura com busca nas bases de dados eletrônicas Medline/Pubmed; Medline e Journals@Ovid/Ovid; Cinahl; Lilacs e Cochrane, a estratégias de busca utilizou os seguintes descritores e palavras-chave: leg ulcer; varicose ulcer; bandage; 'stockings, compression'; venous ulceration; venous ulcer; compressive therapy; compression therapy; stocking. Resultados: A busca resultou em 25 artigos. O uso de bandagem com compressão mostrou-se mais eficaz que a bandagem sem compressão. Bandagens com multicamadas contribuem para a cicatrização das úlceras venosas. O uso da meia elástica e cirurgia corretora do fluxo sanguíneo estão associadas à prevenção da reincidência das úlceras. Conclusão: O tratamento de úlceras venosas utilizando algum tipo de compressão mostrou-se eficiente no processo de cicatrização (AU)

Aim: To identify indexed articles that deal with the use of elastic or inelastic compression therapy as a therapeutic approach for patients with venous leg ulcers. Methods: Systematic review of literature search in the electronic databases Medline/Pubmed; Medline and Journal @Ovid / Ovid; CINAHL; Lilacs and Cochrane, the search strategies used the following descriptors and keywords: leg ulcer; varicose ulcer; bandage; 'Stockings, compression'; venous ulceration; venous ulcer; compressive therapy; compression therapy; stocking. Results: The search yielded 25 articles. The use of bandage compression was more effective than the bandage without compression. Bandages multilayer contribute to the healing of venous ulcers. The use of compression stockings and blood flow brokerage surgery are associated with the prevention of recurrence of ulcers. Conclusion: The treatment of venous ulcers using some type of compression was effective in the healing process (AU)

All about compression: A literature review.

Lower extremity ulcers represent a significant public health problem as they frequently progress to chronicity, significantly impact daily activities and comfort, and represent a huge financial burden to the patient and the health system. The aim of this review was to discuss the best approach for venous leg ulcers (VLUs). Online searches were conducted in Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and reference lists and official guidelines. Keywords considered for this review were VLU, leg ulcer, varicose ulcer, compressive therapy, compression, and stocking. A complete assessment of the patient's overall health should be performed by a trained practitioner, focusing on history of diabetes mellitus, hypertension, dietetic habits, medications, and practice of physical exercises, followed by a thorough assessment of both legs. Compressive therapy is the gold standard treatment for VLUs, and the ankle-brachial index should be measured in all patients before compression application.

A study of the Unna Boot compared with the elastic bandage in venous ulcers: a randomized clinical trial.

OBJECTIVE: to analyze the process of tissue repair in patients with venous ulcers using inelastic compression therapy (the Unna Boot), in comparison with the use of the elastic bandage. METHOD: a controlled randomized clinical trial in which the patients (n=18) were allocated to two groups, those who used the Unna Boot (group B) and those who used the elastic bandage (group A). The study's follow-up period was 13 weeks. RESULTS: a significant reduction took place, at the level of 5%, in the area, in square centimeters, of the ulcers of group B (p<0.0001) throughout the treatment, and there was a tendency of group A for reduction in the area of the ulcer, in centimeters squared (p=0.06), only after the fifth week. CONCLUSION: the treatment with the Unna Boot presented better results in venous ulcers with areas over 10cm², and the elastic bandage with Petrolatum® gauze in venous ulcers below 10cm². Brazilian Clinical Trials Register: Trial (req: 195) and WHO UTN U1111-1122-5489.

Effectiveness of papain gel in venous ulcer treatment: randomized clinical trial.

OBJECTIVE: to assess the effectiveness of 2% papain gel compared to 2% carboxymethyl cellulose in the treatment of chronic venous ulcer patients. METHOD: randomized controlled clinical trial with 12-week follow-up. The sample consisted of 18 volunteers and 28 venous ulcers. In the trial group, 2% papain gel was used and, in the control group, 2% carboxymethyl cellulose gel. RESULTS: the trial group showed a significant reduction in the lesion area, especially between the fifth and twelfth week of treatment, with two healed ulcers and a considerable increase in the amount of epithelial tissue in the wound bed. CONCLUSION: 2% papain gel demonstrated greater effectiveness in the reduction of the lesion area, but was similar to 2% carboxymethyl cellulose gel regarding the reduction in the amount of exudate and devitalized tissue. Multicenter research is suggested to evidence the effectiveness of 2% papain gel in the healing of venous ulcers. UTN number: U1111-1157-2998.

[Use and effectiveness of papain in the wound healing process: a systematic review]. / Uso e efetividade da papaína no processo de cicatrização de feridas: uma revisão sistemática.

This systematic review is aimed at analyzing the evidences about the use of papain in wound healing. A manual and electronic bibliographic research was performed in the following databases: LILACS, Cochrane, IBECS, MEDLINE via Pubmed and CINAHL, using the following terms as descriptors and as word: Carica, Papain and Wound Healing, from 1987 to 2010. The types of studies that predominated were descriptive, exploratory, case studies, case reports and only one randomized controlled clinical trial. The articles showed that papain can be used in wounds of many etiologies and in various healing stages without any specific contraindications, proving to be effective and safe; although there were reports of burning and pain. We conclude that this review contributes to the demonstration of how papain has been used in this period becoming a learning source, besides pointing to the need of further studies conducted with greater methodological rigor.

Profile of students registered in nursing auxiliary and technician courses of the Nursing Worker Professionalization Project (PROFAE) in Rio de Janeiro - Brazil.

This paper aims to present a profile of students registered in the Professional Training Courses for Nursing Auxiliaries and Complementation Courses for Nursing Technicians of the Nursing Worker Professionalization Project - PROFAE. This quantitative study was carried out in the State of Rio de Janeiro, Brazil, from August 2004 to January 2005, through the application of 1,400 questionnaires. Data analysis used descriptive statistics, with simple frequencies and percentages. After tabulation, data were divided in the following categories: sociodemographic data, educational background, family profile, habits, professional activity, salary range, expectations about PROFAE and nursing, difficulties to participate in the project and the teaching-learning process. Students/workers graduated from the PROFAE program tend to improve the quality of hospital and outpatient care, contributing to labor market dynamics in the health sector.