Skin and Soft Tissue Infections in the Surgical Area at the Kara Teaching Hospital

Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 women.The sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University Hospital, with a high mortality rate due to delayed consultations.

Study of the Effectiveness of Papaver Sp. Alkaloids as Future Therapeutic Alternatives against Enterococcus Sp. Causing Hospital-Acquired Septicemic Infections

Background and Objective: In recent years, control of Enterococcus sp. It has been proven in the local medical environment to be a cause of acquired septicemia in various age groups, and medical instruments are considered an effective means of transmitting enterococcal septicemia, and catheters are at the forefront in terms of danger. Based on this risk, this study aimed to monitor the spread of Enterococcus sp., which causes blood poisoning acquired from catheters, and to compare its response to antibiotics with that of those isolated from clinical samples in children, as a first study locally. The effectiveness of alkaloids of different types of Papaver sp. In Syrian plants, they were tested against infection with this bacteria. Materials and Methods: The study dealt with two parts: The first part included collecting clinical samples from the University Children’s Hospital in Damascus/bacterial diagnostic laboratories/then isolating and diagnosing the bacteria by following a set of tests to identify the most prevalent genera and species and comparing their prevalence rate with Enterococcus. The second part;It included collecting plant samples, confirming the species taxonomically, then extracting alkaloids from plant parts (fruit, stem, Flowers), then comparing the extent of resistance of bacterial strains to antibiotics compared to the Enterococcus sp., and then confirming the antibacterial activity of the Papaver sp. alkaloids against Enterococcus sp. Result:In its first part, the study confirmed the significant contribution of the Enterococcus sp. to infections acquired from various sources, largely in catheter tip infections (9.09%) and to a lesser extent in other sources (3.7%), The second part was to confirm the effective-ness of the alkaloid extract of the Papaver sp., especially the two species Papaver syriacum, and Papaver dubium, against Enterococcus sp. with areole diameters that ranged between (15 - 26 mm) for the fruit extract and at a minimum inhibitory concentration (3.12 - 6.25 mml) and then the stem (5 - 20 mm). And the effectiveness of the Flowers extract is very weak to almost non-existent. Conclusions: The catheter and medical sources surrounding the patient constitute a dangerous source of multi-resistant Enterococcus sp., which poses a real threat to the lives of children, with new mechanisms represented by colonization of the skin and the ability to form biofilms Surfaces of medical instruments, with are resistant to a wide range of antibiotics. As an alternative and effective modern source to limit its spread in the future, the alkaloid extract of the fruits and stems of the wild Papaver sp. has proven a strong antibiotic effect, especially the two types: Papaver syriacum and Papaver dubium.

The Prevalence of Methicillin-Resistant Staphylococcus aureus Colonization in Patients with Complicated Skin and Skin Structure Infections after Treatment with Linezolid or Vancomycin

Background: Complicated skin and skin structure infections (cSSSIs) due to Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), are associated with significant morbidity. Re-ducing MRSA carriage has been a focus of infection control interventions. The prevalence of MRSA colonization after successful treatment of a MRSA cSSSI is unknown. Methods: Secondary analysis of a randomized controlled trial comparing linezolid and vancomycin for the treatment of MRSA cSSSI. Adult patients that had a colonization culture, confirmed MRSA cSSSI, received at least one dose of study treatment, and had an outcome recorded at end of study. Patient, clinical characteristics and prevalence of colonization were compared by treatment regimens. A multivariate regression model identified predictors of MRSA colonization at EOS. Results: There were 456 patients evaluated. The prevalence of MRSA colonization was higher for vancomycin treated patients compared to linezolid treated patients at end of treatment (EOT) (28% vs. 5%, p < 0.001) and EOS (34% vs. 22%, p < 0.01). Independent predictors of colonization at EOS after treatment for a MRSA cSSSI included diagnosis, primarily driven by abscess, black race, treatment with vancomycin, MRSA mixed infection and male gender. Conclusion: Patients treated with linezolid for a cSSSI had less MRSA colonization at EOT and EOS compared to those treated with vancomycin. Multiple independent predictors of MRSA colonization were identified. Additional studies evaluating the relationship of MRSA colonization after treatment of cSSSI are needed.

Effectiveness of <i>Thymus vulgaris</i>Essential Oil in the Treatment of Skin Infections in Dogs

Currently, there are no data in the literature on the topical treatment with Thymus vulgaris essential oil (EO) in bacterial skin infections of dogs. This study evaluates the effectiveness of Thymus vulgaris EO for topical use in dogs with skin 18 half-breed dogs, affected by skin infections housed in a rescue shelter were studied. The bacteria isolated from these dogs were identified by MALDI-TOF-MS. The susceptibility of the isolated microorganisms to Thymus vulgaris L. EO was estimated in vitro by bacteriological test (CLSI 2015), in comparison to some antimicrobials drugs (amoxicillin-clavulanic acid, doxycy-cline, thiamphenicol and marbofloxacin) and to Citrus bergamia EO. The dogs, divided in two groups at random, were treated topically for 7 days with Thymus vulgaris L. EO (Group 1: n. 10 animals) and Citrus bergamia Risso e Poiteau EO (Group 2: n. 8 animals) respectively. The bacteria isolated were: Staphylococcus pseudintermedius (7 samples), Staphylococcus sciuri (4), ESBL Escherichia coli (3) and Proteus mirabilis (4). In all animals treated with Thymus vulgaris EO, the clinical signs decreased rapidly within 5 days from the administration, with complete remission 7 days after the treatment. No bacterial growth was observed from skin swabs after 7 days of treatment. None of the treated animals showed local or general side effects. The use of Thymus vulgaris EO could be a possible alternative or additional treatment to antibiotics in dermatological infections, particularly in cases refractory to conventional therapy.

The Frequency of Skin Tumors and Infections in Patients with Autoimmune Diseases

Background: Autoimmune diseases are a vast array of organ-specific as well as systemic diseases, whose pathogenesis results from the activation of B and T lymphocytes reacting against antigens of the body’s own tissues (defined as self). Objective: To record skin tumors and infections in all autoimmune diseases gathered together in a one pathological state, compared with renal transplant recipients and normal control. Patients and Methods: Four hundred patients with different autoimmune diseases were examined. Fifty patients with pemphigus (15 males, 35 females) are aged from 20 - 70 (41.23 ± 3.89) years. Fifty patients with systemic lupus erythematosus (50 females) are aged from 17 - 45 (30.58 ± 10.08) years. One hundred patients with vitiligo (59 males, 41 females) are aged from 9 - 71 (42.89 ± 5.28) years. One hundred patients with alopecia areata (42 males, 58 females) are aged from 7 - 52 (38.67 ± 9.52) years. One hundred patients with psoriasis (56 males, 44 females) are aged from 7 - 71 (47.36 ± 8.62) years were evaluated. One hundred twenty kidney transplant recipients’ (101 males, 19 females) ages ranged from 14 - 70 (45.43 ± 4.63) years. All patients were examined thoroughly for any cutaneous manifestations and tumors and the findings were compared with the general population as a control group, which consisted of 500 healthy control individuals whose ages ranged from 20 - 71 (44.53 ± 11.48) years. This case series, descriptive, controlled study was performed in Baghdad Teaching Hospital from June 2014 to October 2015. Results: In renal transplant recipients, the findings were observed as follow herpetic infection in 30(25%), bacterial 12(10%) while fungal 24(20%) patients. These infections appeared early in the course of immunosuppression. While the tumors were noticed, the benign tumors were the commonest manifestations, which included viral warts in 45(37.5%) followed by actinic keratosis 15(12.5%), seborrheic keratosis 14(11.6%), sebaceous hyperplasia 13(10.8%) and keratoacanthoma 1(0.8%). While the malignant tumors were basal cell carcinoma 4(3.3%) followed by squamous cell carcinoma 3(2.5%), and kaposi’s sarcoma 4(3.3%), Bowen’s disease 1(0.8%). These malignancy usually appeared late in the course of immunosuppression. In pemphigus, viral warts were observed in 4(8%) cases;fungal infection was seen in 4(8%) cases and bacterial infections in 2(4%) of cases and herpetic infection in only 1(2%) of case;no tumors were found in all patients. In vitiligo, viral warts were observed in 2(2%) cases, while seborrhic keratosis and sebaceous hyperplasia were observed in 1(1%) case;herpetic and fungal infections were seen in 3(3%) of cases while bacterial infections were recorded in 2(2%) of cases but no tumors were found in all patients. In alopecia areata viral warts were observed in 9(9%) of cases, sebaceous hyperplasia in 1(1%) case, herpetic and bacterial in 3(3%) of cases and fungal in 4(4%) of cases;no tumors were found in all patients. In systemic lupus erythymatosus (SLE) viral warts were observed in 4(8%) of cases, herpetic infection in 12(12%) of cases, fungal infection in 10(20%) of cases, bacterial infection in 3(3%) of cases and sebaceous hyperplasia in only 1(2%) of case, but no tumors were seen. In psoriasis, viral warts were observed in 14(14%) of cases, herpetic infection in 10(10%) of cases, bacterial infection in 3(3%) of cases, fungal infection in 2(2%) of cases, sebaceous hyperplasia in 2(2%) of cases and seborrhiec hyperkeratosis in 1(1%) case, while no tumors were demonstrated. In healthy control individuals, herpetic infection was present in 36(7.2%) and viral warts in 52(10.4%) individuals, fungal infection in 29(5.8%) of individuals and regarding tumors solar keratosis was present in 24(4.8%);basal cell carcinoma and squamous cell carcinoma were present in 2(0.4%) individuals of each. Conclusions: Patients with autoimmune diseases were protected against infections and tumors while kidney transplant recipients had no such protection although all these groups were on prolonged immunosuppression.

Characterization of <i>Staphylococcus aureus</i>infections among children in an outpatient clinic, China

Objective: We aimed to investigate the epidemiology and identify antibiotic resistance patterns of isolates from children with skin and soft tissue infections attending an outpatient clinic in Southern China. Method: An observational study of outpatient pediatric patients was conducted in a rural area of Guangxi. Infections were characterized in 230 patients and staphylococcal isolates tested for susceptibility to a range of antibiotics. Results: Among the 307 patients, 38.5% were infants. Culture yielded Staphylococcus aureus (S. aureus) in 230 patients, of which 24 (10.4%) were methicillin-resistant S. aureus (MRSA). Staphylococcal strains were most isolated from hand, foot and umbilicus. The 1-12 mon group had the highest staphylococcal infection rate (86%), followed by the 6-12 year group, but MRSA was more common in the older children (19.5% of S. aureus). MRSA had significantly more resistance than MSSA to chloromycin (46% vs 11%), clindamycin (67% vs 19%), gentamicin (33% vs 2%), rifampicin (25% vs 2.9%), and sulphamthoxazole-trimethoprim (17% vs 3%). Conclusion: S. aureus remains a leading cause of pediatric skin and soft tissue infections. Over 10% of isolates were methicillin-resistant with high rates of resistance to non-beta lactam antibiotics, reducing options for therapy and limiting choices for empirical treatment.

Skin Manifestations of HIV Infection in Children in Pediatric Services of Conakry University Hospital (Guinea)

Introduction: Dermatological manifestations during HIV infection play a diagnostic and prognostic role. They are observed in 83% - 98% of patients at the late stage of AIDS and 58% - 75% at an early stage of AIDS. The objective of this study was to determine the prevalence of skin diseases in HIV in children, describes the demographic profile and identify key dermatoses. Material and methods: This was a prospective study of descriptive kind conducted from August 25, 2009 to February 25, 2010. It involved children infected with HIV followed in pediatric services at the University Hospital of Conakry. All children were examined by an experienced dermatologist. The diagnosis of dermatosis was made according to the clinical signs. The stages of HIV infection were determined according to the WHO classification. Each child received retroviral serology rapid tests according to national algorithm. Results: Among 119 HIV-positive children 65 showed mucocutaneous manifestations, there are 34 girls and 31 boys, all HIV-1 infected with 66.16% in stage III disease. The average age was 7 years, ranging from 11 months to 15 years. 66.15% of the children were from married mothers and more than half of the mothers were illiterate. They were all positive for HIV1. Oral candidiasis (38.46%), prurigo (29.23%) and molluscum contagiosum (7.69%) were the most common skin diseases;52.31% had at least two associated dermatoses. The candidiasis-prurigo combination (26.47%) was the most common. Dermatosis was often associated with other conditions: malaria (30.76%), pulmonary tuberculosis (25.61%) and malnutrition (12.30%). Discussion: With 65 cases diagnosed in six months our study shows that skin diseases are common in HIV among children in Guinea. The prevalence and socio-demographic characteristics are close to those reported by sub saharian and North African authors. A special feature of the study is that most mothers are illiterate and are infected with HIV, which would have favored the contamination of these children. Conclusion: In Sub-Saharan Africa where the rate of pediatric HIV infection is increasing, it is important to identify the mucocutaneous manifestations for optimal care.

Latent tuberculosis infection in health-care workers in the government sector in Brunei Darussalam:A cross-sectional study

Objective:Health-care workers(HCWs)are known to be at high risk for occupational biological hazards,and this includes exposure to mycobacterium tuberculosis(TB)which can result in either active or latent TB infection(LTBI).This study aims to provide an overview of the incidence of LTBI among HCWs in Brunei Darussalam,to examine associated risk factors,and to evaluate LTBI treatment compliance.Materials and Methods:This is a retrospective cross-sectional study which was conducted using data from January 2018 to December 2021,on notified cases of LTBI in HCWs which identified 115 cases.Demographic data,underlying medical conditions,and compliance to treatment were assessed through reviews of their electronic health records.Results:The incidence of LBTI was 14.6/year/1000 HCWs.The incidence rate reached a high of 24.6/1000 in 2020,and majority of cases were in the older age groups.There was good treatment acceptance and compliance(82.6%),and this was observed to be significantly higher in females than males(P=0.02).Conclusion:This study showed an average incidence of LTBI of 14.6/1000 HCWs over 4 years and high LTBI treatment acceptance(82.6%)and compliance.Emphasis on infection prevention and control measures in health-care settings and actions to increase awareness of LTBI are crucial interventions toward reducing the burden of LTBI.

肝硬化失代偿期患者皮肤感染致脓毒性休克的护理

总结1例肝硬化失代偿期患者皮肤软组织非特异性感染致脓毒性休克的护理体会。护理要点:以目标平均动脉压为导向,实施液体复苏;加强全程营养管理,加速创面修复;肝硬化失代偿期间,出血与血栓防范护理;加强院感管理,预防院内感染。经过45 d个性化的治疗和护理,双下肢植皮存活,无院内感染发生,患者康复出院。

基于两种方法筛查常州市高校学生结核潜伏感染结果比较

目的了解常州地区高校学生结核潜伏感染现状,比较结核分枝杆菌素释放试验(tuberculosis skin test,TST)和结核分枝杆菌特异性细胞免疫反应(QuantiFERON-TB Gold In-tube,QFT)检测2种方法一致性。方法2020年采用整群抽样方法,选取常州市两所高校共625名学生进行TST和QFT检测,并进行为期2年的结核病病例监测。结果625名学生中,筛查出结核潜伏感染118人,检出率为18.88%(95%CI:15.94%~21.82%);其中单TST检测阳性率为15.20%,单QFT检测阳性率为10.72%,双阳性率为7.04%。以TST硬结直径≥5 mm为阳性判断标准时,两种检测方法的一致性为中等(Kappa值=0.48,P<0.01);以≥10 mm、≥15mm为阳性判断标准时两种方法一致性均较差(Kappa值=0.33、0.21,P值均<0.01)。筛查出结核潜伏感染118名学生中,参与预防性服药39名(占33.05%)。2年随访确诊为活动性结核病3例,2年累计发病率为0.48%。结论建议在TST硬结直径≥10 mm学生中加做QFT试验,且对单纯TST强阳性或QFT阳性学生采取预防性服药措施,有结核病接触史学生应作为结核筛查和预防性服药重点人群。

中药复方MHC-20的抗化脓性链球菌功效与作用机制探究

以化脓性链球菌(Streptococcus pyogenes)为研究对象,探究了MHC-20的抑菌性能及作用机制。通过微量肉汤稀释法以及常量稀释法测得MHC-20对化脓性链球菌的MIC值为31.25μg/mL或0.31%,并且对金黄色葡萄球菌以及白色念珠菌等均有较强杀伤作用。瞬时杀菌活性结果表明:MHC-20在5 min时可以完全杀死化脓性链球菌。定量生物膜与疏水性测定结果表明:MHC-20能够极显著降低化脓性链球菌细胞表面疏水性(P<0.0001)以及极显著抑制生物膜的形成(P<0.01)。细胞膜通透性测定结果表明:MHC-20作用下菌液相对电导率、碱性磷酸酶均上升、蛋白严重泄露,并且呈浓度依赖性。扫描电子显微镜结果表明:MHC-20对菌体形态有很强的破坏作用。最后,构建了小鼠化脓性链球菌皮肤感染模型,结果表明:复方MHC-20可以促进创口恢复,极显著抑制创口的细菌(P<0.01),5%MHC-20与20%MHC-20均极显著降低小鼠血清以及创口炎症因子IL-6表达(P<0.001),20%MHC-20极显著降低白细胞的表达(P<0.01),综上所述,MHC-20有望成为广谱抗菌剂以及抗化脓性链球菌皮肤感染的有效药物。

腹膜透析导管出口周围疖肿的发生情况及影响因素分析

目的探讨腹膜透析(peritoneal dialysis,PD)导管出口周围疖肿的发生情况及影响因素。方法选择2011年9月─2017年9月北京大学人民医院肾内科规律随访的PD患者,回顾其PD导管出口周围疖肿的发生情况及临床资料,分析其相关影响因素。结果183名PD患者入选研究,男性88例(占48.1%),平均年龄(59.8±13.8)岁,透析龄27(15,51)月。其中23名(12.6%)患者发生36例次出口周围疖肿,发生率0.05次/风险年。14例次(占38.9%)患者疖肿发生部位以PD导管为中心、周围6~9点的位置。并发症方面:4例次(占11.1%)疖肿合并出口和/或隧道感染,无合并腹膜炎。Logistic回归分析结果显示:透析龄(OR=0.969,95%CI:0.941~0.998,P=0.039)、合并糖尿病(OR=3.014,95%CI:1.050~8.651,P=0.040)、血C反应蛋白(OR=1.154,95%CI:1.065~1.251,P<0.001)是PD患者出口周围发生疖肿的独立危险因素。通过Logistic回归分析PD患者出口疖肿频发的相关因素,结果显示合并糖尿病(OR=5.513,95%CI:1.029~29.536,P=0.046)、C反应蛋白(OR=1.103,95%CI:1.016~1.197,P=0.019)是出口周围疖肿频发的独立危险因素。结论PD导管出口周围疖肿形成在PD患者中并不少见,可能发展为出口感染和/或隧道感染。对合并糖尿病、透析龄较短、C反应蛋白水平高的患者应重点关注出口周围疖肿的发生,并给予相应的预防宣教,从而预防出口和/或隧道感染。

反复误诊的偶发分枝杆菌感染一例

医源性偶发分枝杆菌感染多与手术伤口、器官移植、透析和注射等有关。本文报道注射后发生的偶发分枝杆菌感染一例,曾多次被误诊为“软组织感染、坏疽性脓皮病”等,最终通过病理、培养和PCR测序确诊,并对分离菌株体外药敏试验。患者经亚胺培南西司他丁钠、阿米卡星、环丙沙星等药物治疗后痊愈,随访5年,患儿无不良反应发生。

免疫缺陷儿童诺卡菌病后造血干细胞移植一例并文献复习

诺卡氏菌病是一种人畜共患病,机会性侵入机体后引起不同程度的人畜疾病,免疫抑制或缺陷个体易感,缺乏临床特异性表现的罕见病。近年来,病例报道明显增加,本文阐述儿童诺卡菌肺部及皮肤感染治愈后进行造血干细胞移植术1例,回顾诺卡氏菌的概述、感染途径及致病性、诊断及治疗等进行综述。

五味消毒饮疗法对膀胱癌泌尿造口患者造口并发症的影响

目的探讨五味消毒饮对膀胱癌泌尿造口患者造口周围感染、造口并发症及造口愈合的影响。方法选取2023年1—7月于南昌大学第一附属医院拟行泌尿造口术的74例膀胱癌患者为研究对象,将收治于一病区的患者归为对照组,收治于二病区患者归为观察组,每组各37例。对照组采用生理盐水冲洗造口,观察组采用五味消毒饮(组方:金银花30 g,野菊花、蒲公英、紫花地丁各15 g,紫背天葵子10 g)外用冲洗加内服,2组均干预3个月。采用TIME-H评估量表评价造口周围皮肤愈合情况,并比较2组造口感染率、并发症发生率。结果干预1个月时,2组造口感染率、并发症发生率及造口周围皮肤愈合等比较差异无统计学意义(P>0.05);干预3个月时,观察组造口感染率、并发症发生率均低于对照组,造口周围皮肤愈合情况好于对照组(P<0.05)。结论与生理盐水冲洗泌尿造口相比,五味消毒饮冲洗疗法能够减少泌尿造口并发症,降低泌尿造口周围皮肤感染率,促进造口周围皮肤愈合。

艾拉普林的研究进展

抗菌药物耐药性已成为全球面临的主要健康威胁,临床迫切需要新的抗菌药物以应对革兰氏阳性耐药菌感染。艾拉普林(英文名iclaprim)是Arpida公司开发的抗革兰氏阳性菌新药,是一种二氢叶酸还原酶抑制剂,现已获批用于治疗革兰氏阳性菌的皮肤、软组织感染和院内获得性肺炎的临床试验,目前已完成III期临床试验。研究表明,艾拉普林具有良好的组织分布,在体内、体外均有良好的抗菌活性,抗革兰氏阳性菌活性非劣效万古霉素,不良反应发生率与万古霉素类似,无肾毒性,抗菌谱包括全部革兰氏阳性菌、部分革兰氏阴性菌、非典型病原体、卡氏肺孢子。艾拉普林因体内分布广、蛋白结合率高、肺内浓度、药物不良反应少、良好耐受性等特点,有望成为治疗革兰氏阳性耐药菌感染的治疗药物。本研究综述了艾拉普林药理学、抗病原微生物活性、抗菌活性、药代动力学等各方面的研究进展,旨在为开发和治疗革兰氏阳性耐药菌感染的新兴治疗药物提供借鉴。

多技术联合治疗大面积烧伤疗效分析

目的探讨分析湿润烧伤膏+Meek植皮+悬浮床治疗大面积烧伤的临床疗效。方法选取2019年2月至2022年3月中国人民解放军联勤保障部队第九九〇医院收治的62例大面积烧伤患者(烧伤总面积>50%TBSA)作为研究对象,按照不同治疗方法将其分为研究组(31例)和对照组(31例)。研究组患者采用湿润烧伤膏+Meek植皮+悬浮床治疗,对照组患者采用湿润烧伤膏+Meek植皮治疗,对比观察两组患者植皮面积、皮片成活率、烧伤创面愈合时间、供皮区创面愈合时间及治疗期间感染情况。结果研究组患者植皮面积(41.84±5.27)%TBSA与对照组患者植皮面积(43.07±6.35)%TBSA无明显差异(t=0.830,P=0.410),皮片成活率(87.83±5.34)%明显高于对照组患者皮片成活率(79.86±8.53)%(t=4.410,P<0.001),烧伤创面愈合时间(21.87±4.64)d及供皮区创面愈合时间(19.31±4.48)d均明显短于对照组患者烧伤创面愈合时间(24.59±5.57)d及供皮区创面愈合时间(21.74±4.89)d(t=2.089、2.040,P=0.041、0.046)。治疗期间,研究组患者并发创面感染8例、血液感染3例,明显少于对照组患者的并发创面感染16例、血液感染11例(χ2=4.351、5.905,P=0.037、0.015)。结论湿润烧伤膏+Meek植皮+悬浮床治疗可明显提高大面积烧伤患者植皮术后皮片成活率,缩短创面愈合时间,降低感染风险。

艾叶/茶叶水提物促进皮肤感染模型大鼠创面愈合的协同作用及机制研究

目的探讨艾叶水提物和茶叶水提物对皮肤感染模型大鼠的协同治疗作用及其机制。方法实验分两个部分进行:第一部分将皮肤感染模型大鼠随机分为模型组、西药组、艾叶水提物组、茶叶水提物组、2∶1组(艾叶水提物与茶叶水提物质量比为2∶1)、1∶1组(艾叶水提物与茶叶水提物质量比为1∶1)和1∶2组(艾叶水提物与茶叶水提物质量比为1∶2),每组7只。比较治疗前后各组大鼠创面面积;ELISA法检测各组大鼠血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-18水平。第二部分随机选取7只大鼠为正常组,将皮肤感染模型大鼠随机分为模型组、2∶1组(艾叶水提物与茶叶水提物质量比为2∶1),每组7只。Western blot法检测各组大鼠皮肤组织黑色素瘤缺乏因子2(absent in melanoma 2,AIM2)、含有CARD的凋亡相关斑点样蛋白(apoptosis-associated speck-like protein containing CARD,ASC)和Caspase-1蛋白表达水平;ELISA法检测各组大鼠血清AIM2、ASC、Caspase-1及IL-1β、IL-18水平。结果第一部分,与模型组比较,西药组、艾叶水提物组、茶叶水提物组和3个不同比例组感染创口收缩明显,创面面积明显减小,且促炎因子TNF-α、IL-1β、IL-18的表达水平均显著降低(P<0.05)。其中西药组、2∶1组效果更明显,两组促炎因子TNF-α、IL-1β水平比较,差异无统计学意义(P>0.05)。第二部分,与正常组比较,模型组感染创面组织中AIM2、ASC、Caspase-1蛋白表达水平和血清IL-1、IL-18水平均显著升高(P<0.05)。与模型组比较,2∶1组感染创面组织中AIM2、ASC、Caspase-1蛋白表达水平和血清IL-1、IL-18水平均显著降低(P<0.05)。结论艾叶水提物和茶叶水提物对治疗皮肤感染模型大鼠存在协同作用,艾叶水提物与茶叶水提物质量比为2∶1是最优比例。其协同机制可能与AIM2炎症小体活化和细胞焦亡通路有关。

量化评估策略下的手术室护理结合葡萄糖氯己定皮肤消毒液备皮对直肠癌患者术后感染的影响

目的:为了探究量化评估策略下的手术室护理结合葡萄糖氯己定皮肤消毒液备皮对直肠癌患者术后感染的影响。方法:选取2020年9月—2022年9月郑州大学第一附属医院进行手术治疗的86例直肠癌患者作为研究对象,采用随机数表法分为对照组和试验组,每组各43例。对照组患者给予常规护理干预结合葡萄糖氯己定皮肤消毒液备皮,试验组患者实施基于量化评估策略下的手术室护理干预结合葡萄糖氯己定皮肤消毒液备皮。结果:试验组患者的住院时间、术中出血时间、术后首次排气时间以及术后首次排便时间均显著短于对照组,差异有统计学意义(t=7.371、5.318、8.257、9.262,P<0.05);试验组患者的肾上腺素指标、去甲肾上腺素指标以及血清皮质醇指标均显著低于对照组,差异有统计学意义(t=6.145、6.772、10.537,P<0.05);试验组并发症发生率显著低于对照组,差异有统计学意义(χ^(2)=3.890,P<0.05);试验组患者护理满意度显著高于对照组,差异有统计学意义(χ^(2)=8.870,P<0.05)。结论:直肠癌患者在手术的过程中使用量化评估策略下的手术室护理结合葡萄糖氯己定皮肤消毒液备皮,可以有效优化患者的手术指标,减轻患者术后应激程度,降低并发症发生率,提高患者对护理的满意程度。

中国肾移植受者结核病临床诊疗指南(2023版)

本指南旨在为肾移植受者结核病的临床管理提供全面而实用的指导。首先,概述了肾移植受者结核病的特殊性,强调了其高发生率及临床表现的多样性。为了更好地理解患者的病情,建议在移植前进行结核病相关的评估,并注意移植术后对结核病的监测。在诊断方面,详细介绍了目前常用的结核病诊断方法,并提供了在肾移植受者中的适用性评估。在确诊后,讨论了在免疫抑制药应用的背景下,如何平衡结核病治疗和排斥反应的策略,并关注了潜在的药物相互作用。预防方面,强调了在肾移植前对结核病的筛查。本指南旨在提高医务人员对肾移植受者结核病管理的认知,促进更有效的临床实践,提高受者的生活质量。