Excessive Exudate Research Articles

Superabsorbent curdlan-based foam dressings with typical hydrocolloids properties for highly exuding wound management

Effective management of chronic wounds with excessive exudate may be challenging for medical doctors. Over the years, there has been an increasing interest in the engineering of biomaterials, focusing on the development of polymer-based wound dressings to accelerate the healing of exuding wounds. The aim of this study was to use curdlan, which is known to support wound healing, as a base for the production of superabsorbent hybrid biomaterials (curdlan/agarose and curdlan/chitosan) with the intended use as wound dressings for highly exuding wound management. To evaluate the biomedical potential of the fabricated curdlan-based biomaterials, they were subjected to a comprehensive assessment of their microstructural, physicochemical, and biological properties. The obtained results showed that foam-like biomaterials with highly porous structure (66–77%) transform into soft gel after contact with the wound fluid, acting as typical hydrocolloid dressings. Novel biomaterials have the superabsorbent ability (1 g of the biomaterial absorbs approx. 15 ml of exudate) with horizontal wicking direction while keeping dry edges, and show water vapor transmission rate of approx. 1700–1800 g/m2/day which is recommended for optimal wound healing. Moreover, they are stable in the presence of collagenases, but prone to biodegradation in lysozyme solution (simulated infected wound environment). Importantly, the developed biomaterials are non-toxic and their surface hinders fibroblast attachment, which is essential during dressing changes to avoid damage to newly formed tissues in the wound bed. All mentioned features make the developed biomaterials promising candidates to be used as the wound dressings for the management of chronic wounds with moderate to high exudate.

Aloe Vera extract-based composite nanofibers for wound dressing applications

Natural, biocompatible, and biodegradable composite nanofibers made of Aloe vera extract, pullulan, chitosan, and citric acid were successfully produced via Forcespinning® technology. The addition of Aloe vera extract at different weight percent loadings was investigated. The morphology, thermal properties, physical properties, and water absorption of the nanofibers were characterized using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA). The developed nanofiber membranes exhibited good water absorption capabilities, synergistic antibacterial activity against Escherichia coli, and promoted cell attachment and growth. Its porous and high surface area structure make it a potential candidate for wound dressing applications due to its ability to absorb excessive blood and exudates, as well as provide protection from infection while maintaining good thermal stability.

Unidirectional Water-Transport Antibacterial Trilayered Nanofiber-Based Wound Dressings Induced by Hydrophilic-Hydrophobic Gradient and Self-Pumping Effects

Excessive wound exudates often cause infection and hinder wound repair and regeneration. It is therefore urgently needed to develop an ideal wound dressing for pumping the excessive biofluids and inhibiting bacterial infection in the wound healing process. Herein, we demonstrate a facile and efficient strategy to fabricate the unidirectional water-transport antibacterial wound dressings by embedding macromolecular antimicrobials into a multilayer nanofibrous membrane featured with hydrophobic-to-hydrophilic gradient structure and self-pumping effect using an electrospinning technique. Thanks to these features, the obtained nanofibrous dressings achieved excellent unidirectional water-transport performance, which could drive wound exudates to flow spontaneously from inside to outside and prevent pumped biofluids rewetting the wounds. In addition, the designed trilayered dressing exhibited approximately 100% antibacterial ability against Staphylococcus aureus and Escherichia coli when the concentration of antibacterial agents polyhexamethylene guanidine hydrochloride (PHGC) was 0.06 wt%. Moreover, the trilayered dressings revealed excellent water absorption performance, air and moisture permeability, mechanical strength, biocompatibility, and low cell adhesion behavior, indicating the potential applications for the trilayered nanofibrous wound dressings in wound care.

A soft silicone foam dressing that aids healing and comfort in oncology care.

Maintaining skin integrity plays a key role in the ongoing care and comfort of patients at the end of life. Unfortunately, patients receiving cancer treatments are at higher risk of altered skin integrity. Cancer treatments involve multiple modalities, all of which impair wound healing. Excess exudate can be distressing to patients, resulting in catastrophic damage to the wound bed and surrounding skin, reducing quality of life and increasing the need for specialist services. This article describes the use of the Kliniderm foam silicone range of dressings, in combination with best practice, in the treatment of wounds in the oncology setting. The case study evidence presented indicates that this range of dressings is useful in the management of radiotherapy and oncology wounds. It had a positive effect on the exudate level, wound-association pain and the peri-wound skin in these patients, aiding the management of the wound bed.

MANAGEMENT OF VICHARCHIKA (LICHEN SIMPLEX CHRONICUS) BY SHAMANA CHIKITSA: A CASE STUDY

In Ayurveda, most of the skin diseases are included under Kushtha. It can be classified into two groups which are Mahakushtha and Kshudrakushtha. Vicharchika is one among the Kshudrakushtha. According to classical texts, it can be characterised by Kandu (itching sensation), Shyava (blackish brown discolouration), Pidaka (eruptions), Bahusrava (excessive exudation), Raji (marked lining/lichenification), Atiruja (excessive pain) and Rukshata (dryness). Vicharchika can be correlated with Lichen Simplex Chronicus (LSC) based on its clinical presentation. LSC is a highly pruritic, circumscribed plaque or plaques of lichenified skin due to chronic scratching or rubbing. Vicharchika can be treated with Nidan parivarjana (Avoidance of etiological factors), Shodhana chikitsa (Purification therapy) and Shamana chikitsa (Palliative therapy). The present case study deals with a 45 years old male patient having complaints of severe itching in the palm of both hands associated with marked lining, dryness and thickened skin at the affected site for 5-6 months. This case is diagnosed as Vicharchika (Lichen Simplex Chronicus). For treatment Shamana chikitsa was administered for 1 month which showed good result.

Unidirectional water-transport antibacterial trilayered nanofiber-based wound dressings induced by hydrophilic-hydrophobic gradient and self-pumping effects

Excessive wound exudates often cause infection and hinder wound repair and regeneration. It is therefore urgently needed to develop an ideal wound dressing for pumping the excessive biofluids and inhibiting bacterial infection in the wound healing process. Herein, we demonstrate a facile and efficient strategy to fabricate the unidirectional water-transport antibacterial wound dressings by embedding macromolecular antimicrobials into a multilayer nanofibrous membrane featured with hydrophobic-to-hydrophilic gradient structure and self-pumping effect using an electrospinning technique. Thanks to these features, the obtained nanofibrous dressings achieved excellent unidirectional water-transport performance, which could drive wound exudates to flow spontaneously from inside to outside and prevent pumped biofluids rewetting the wounds. In addition, the designed trilayered dressing exhibited approximately 100% antibacterial ability against Staphylococcus aureus and Escherichia coli when the concentration of antibacterial agents polyhexamethylene guanidine hydrochloride (PHGC) was 0.06 wt%. Moreover, the trilayered dressings revealed excellent water absorption performance, air and moisture permeability, mechanical strength, biocompatibility, and low cell adhesion behavior, indicating the potential applications for the trilayered nanofibrous wound dressings in wound care.

Cryogel/hydrogel biomaterials and acupuncture combined to promote diabetic skin wound healing through immunomodulation

Unhealed chronic wounds often deteriorate into multiple infection with several kinds of bacteria and excessive proteolytic wound exudate and remains one of the common healthcare issues. Here, the functional and antimicrobial hydrogel and cryogel biomaterials were prepared from glycol chitosan and a novel biodegradable Schiff base crosslinker difunctional polyurethane (DF-PU). The cryogel exhibited ~2730 ± 400% of water absorption with abundant macropores and 86.5 ± 1.6% of porosity formed by ice crystal as well as ~240% cell proliferation effect; while the hydrogel demonstrated considerable antimicrobial activity and biodegradability. As an optimized procedure to treat the diabetic skin wound in a rat model, the combined application of adipose stem cell-seeded cryogel/hydrogel biomaterials on the wound and acupuncture surrounding the wound may attain 90.34 ± 2.3% of wound closure and secure the formation of granulation tissue with sufficient microvessels and complete re-epithelialization in 8 days. The average increases in the superficial temperature of wounded animals after acupuncture were about 1–2 °C. Through the activation of C3a and C5a, the increased secretion of cytokines SDF-1 and TGFβ-1, as well as the down-regulation of proinflammatory cytokines TNF-α and IL-1β, the combined treatment of stem cell-seeded cryogel/hydrogel biomaterials and acupuncture on wounds produced synergistic immunomodulatory effects. The strategy using the combined treatment of biomaterials, stem cells, and acupuncture reveals a perspective new approach to accelerate the tissue regeneration.

Patient care after surgery: suture care and wound care process

Background. A wound is a defect of skin and underlying tissues that can be caused by many factors. Wound care is more than just changing dressings. Different wounds require different approaches and care. Optimal wound care supports the natural healing process in an effective but gentle way. Wounds are classified into acute and chronic, as well as cut, scalped, chopped, stabbed, bruised, torn, bitten, gunshot, and surgical. Surgical wounds are distinguished by the fact that they are applied specifically, for medical or diagnostic purposes, in special aseptic conditions, with minimal tissue trauma, in conditions of anesthesia, with thorough hemostasis and joining of separated anatomical structures with sutures.
 Objective. To describe the modern approach to wound care.
 Materials and methods. Analysis of literature data on this topic.
 Results and discussion. Types of wound healing include primary tension healing, delayed primary tension healing, secondary tension healing, and scab healing. When caring for surgical wounds, primary protection against microorganisms is important. In this case, sterile dressings play an important role, for example, a medical surgical patch with an absorbent pad (Yu-Fix, “Yuria-Pharm”). The pad is characterized by high hygroscopicity, does not stick to the wound and does not leave fibers in the wound. The frequency of dressings changing depends on the healing process and the amount of exudate released from the wound. For festering wounds, the dressing should be changed daily and sometimes more often. Hands and gloves should be worn before bandaging. After removing the gloves, the hands are also treated with an antiseptic (Gorosten, “Yuria-Pharm”, a decamethoxine-based antiseptic). The use of Gorosten in medical institutions for prophylactic purposes is indicated for disinfection of staff hands in order to prevent the spread of transient microflora. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. However, in this period there are still wound channels from the threads, so after that it is necessary to treat the wound several times with antiseptic (Dekasan, “Yuria-Pharm”). Signs of local infection of the wound are redness, excess exudate, sometimes – with the addition of pus, odor, pain in the area of injury, fever, edema. Sometimes postsurgical wound suppuration occurs even with proper care due to weak immunity or rejection of surgical suture material. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. Unlike 2 % povidone-iodine, which causes severe inhibition of granulation in an open wound, Dekasan does not damage granulation tissue. Surgical treatment, lavage, drainage, antibiotics, laser or ultrasound may also be required. After removing the signs of local inflammation, secondary sutures are applied to the wound or the edges of the wound are connected with the help of adhesive plaster. Before starting the wound care procedure, it is necessary to assess the condition of the wound bed, the nature of the exudate, the condition of the tissues around the wound, pain, wound size. Wound management should involve a multidisciplinary approach. For example, an endocrinologist, a diabetic foot specialist, a purulent surgery surgeon, a vascular surgeon, and a nurse are involved in the treatment of ulcerative defects in patients with diabetes. In the treatment of wounds it is necessary to maintain a humid environment in the wound, maintain a constant temperature without hypothermia, provide adequate drainage and not too tight tamponade, use additional means of healing (eg, unloading the foot in the treatment of foot ulcers in patients with diabetes).
 Conclusions. 1. Optimal wound care supports the natural healing process in an effective but gentle way. 2. When caring for surgical wounds, primary protection against the effects of microorganisms is important. 3. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. 4. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. 5. Wound management should involve a multidisciplinary approach.

Soybean oil-derived non-isocyanate polyurethanes containing azetidinium groups as antibacterial wound dressing membranes

Biobased non-isocyanate polyurethane (NIPU) membranes having physicomechanical and biological properties suitable for application as wound dressings are introduced in this work. Soybean oil with cyclic carbonate groups made through the reaction of epoxidized soybean oil with carbon dioxide gas was reacted with tetraethylenepentamine. The product with free secondary amines was further treated with epichlorohydrin to produce azetidinium containing cross-linked networks. Cationic azetidinium groups offered 100% antibacterial performance against different bacteria. Neither dressings nor their extracted leachates showed cytotoxicity against Fibroblasts. Dressings could preserve damaged skin tissue from external forces as they showed desired tensile properties (~6 MPa tensile strength, ~200% elongation at break), which preserved under a hydrated state. Due to the ability of dressings for absorption (equilibrium water absorption up to ~30%) or evaporation of excess exudates as vapor (water vapor transmission rate of 390 up to 710 g/m2/day for dry and wet dressing), they could preserve a moist environment over low to moderately exuding wounds. Therefore, the encouragement of healing of wounded skin tissue under a hygiene condition is attainable by these dressings.

Safe and effective wound care during the COVID-19 pandemic.

Safe and effective wound care during the COVID-19 pandemic.

An Overview of Biopolymeric Electrospun Nanofibers Based on Polysaccharides for Wound Healing Management.

Currently, despite the thoroughgoing scientific research carried out in the area of wound healing management, the treatment of skin injuries, regardless of etiology remains a big provocation for health care professionals. An optimal wound dressing should be nontoxic, non-adherent, non-allergenic, should also maintain a humid medium at the wound interfacing, and be easily removed without trauma. For the development of functional and bioactive dressings, they must meet different conditions such as: The ability to remove excess exudates, to allow gaseous interchange, to behave as a barrier to microbes and to external physical or chemical aggressions, and at the same time to have the capacity of promoting the process of healing by stimulating other intricate processes such as differentiation, cell adhesion, and proliferation. Over the past several years, various types of wound dressings including hydrogels, hydrocolloids, films, foams, sponges, and micro/nanofibers have been formulated, and among them, the electrospun nanofibrous mats received an increased interest from researchers due to the numerous advantages and their intrinsic properties. The drug-embedded nanofibers are the potential candidates for wound dressing application by virtue of: Superior surface area-to volume ratio, enormous porosity (can allow oxy-permeability) or reticular nano-porosity (can inhibit the microorganisms’adhesion), structural similitude to the skin extracellular matrix, and progressive electrospinning methodology, which promotes a prolonged drug release. The reason that we chose to review the formulation of electrospun nanofibers based on polysaccharides as dressings useful in wound healing was based on the ever-growing research in this field, research that highlighted many advantages of the nanofibrillary network, but also a marked versatility in terms of numerous active substances that can be incorporated for rapid and infection-free tissue regeneration. In this review, we have extensively discussed the recent advancements performed on electrospun nanofibers (eNFs) formulation methodology as wound dressings, and we focused as well on the entrapment of different active biomolecules that have been incorporated on polysaccharides-based nanofibers, highlighting those bioagents capable of improving the healing process. In addition, in vivo tests performed to support their increased efficacy were also listed, and the advantages of the polysaccharide nanofiber-based wound dressings compared to the traditional ones were emphasized.

Highly absorptive dressing composed of natural latex loaded with alginate for exudate control and healing of diabetic wounds

Wounds can take longer to heal in diabetic patients, increasing the risk of infections and other complications. The most common wounds in diabetic patients are diabetic foot ulcers, a severe complication associated with diabetes mellitus. The United States alone spends $18.7 billion annually on care for these wounds including pain and infection management. If improperly managed, infected lesions may require amputation. The enormous cost associated with wound care and the dire consequences if not cared for properly, emphasize the need to develop strategies to accelerate the healing of diabetic foot wounds. Natural rubber latex (NRL), extracted from Hevea brasiliensis (the rubber tree), has been widely applied as a carrier system for several pharmacologically active compounds. Furthermore, it has been shown to encourage angiogenesis, facilitate cell adhesion, and accelerate wound healing. When NRL dressings are applied to wounds of diabetic patients, exudate release is upregulated. The production of exudate is essential to wound healing as it provides the nutrients, proteins, cells, and environment required for regeneration. Despite its benefits, it is necessary to control excess exudate to avoid prolonged healing resulting from dermatitis, maceration of the wound edges, and lesion growth. In order to solve the problem of excessive exudate release induced by NRL membrane application, we aimed to regulate humidity by absorbing excess exudate and increase water vapor transmission. We developed a highly absorptive, permeable, alginate loaded NRL dressing. Adding alginate to NRL membranes, swelling was increased up to 80-fold, absorbing 4.80 g of water per gram of dry membrane. Moreover, water vapor transmission was improved drastically as the material transmitted 480% more water vapor than pure NRL membranes. Furthermore, in vitro tests demonstrated not only that the membranes are biocompatible, but that they also enhance cell proliferation. Through a cell proliferation assay, we observed that fibroblast proliferation was improved by the presence of NRL while the keratinocytes benefit from the presence of alginate. The NRL-alginate dressings have great potential to improve diabetic wound care by accelerating the healing process.

Growth factor loaded in situ photocrosslinkable poly(3-hydroxybutyrate-co-3-hydroxyvalerate)/gelatin methacryloyl hybrid patch for diabetic wound healing

Management of chronic diabetic ulcers remains as a major challenge in healthcare which requires extensive multidisciplinary approaches to ensure wound protection, management of excess wound exudates and promoting healing. Developing wound healing patches that can act as a protective barrier and support healing is highly needed to manage chronic diabetic ulcers. In order to boost the wound healing potential of patch material, bioactive agents such as growth factors can be used. Porous membranes made of nanofibers generated using electrospinning have potential for application as wound coverage matrices. However, electrospun membranes produced from several biodegradable polymers are hydrophobic and cannot manage the excess exudates produced by chronic wounds. Gelatin-methacryloyl (GelMA) hydrogels absorb excess exudates and provide an optimal biological environment for the healing wound. Epidermal growth factor (EGF) promotes cell migration, angiogenesis and overall wound healing. Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) membranes provide microbial, thermal and mechanical barrier properties to the wound healing patch. Herein, we developed a biodegradable polymeric patch based on the combination of mechanically stable electrospun PHBV, GelMA hydrogel and EGF for promoting diabetic wound healing. In vitro and in vivo studies were carried out to evaluate the effect of developed patches on cell proliferation, cell migration, angiogenesis and wound healing. Our results showed that EGF loaded patches can promote the migration and proliferation of multiple types of cells (keratinocytes, fibroblasts and endothelial cells) and enhance angiogenesis. In situ development of the patch and subsequent in vivo wound healing study in diabetic rats showed that EGF loaded patches provide rapid healing compared to control wounds. Interestingly, 100 ng EGF per cm2 of the patches was enough to provide favourable cellular response, angiogenesis and rapid diabetic wound healing. Overall results indicate that EGF loaded PHBV-GelMA hybrid patch could be a promising approach to promote diabetic wound healing.

Surgical Approach to Control Advanced Coats Disease

Coats disease, first described by George Coats in 1908, is commonly a unilateral clinical entity characterized by leaky telangiectatic vessels leading to progressive subretinal exudation and exudative retinal detachment (ERD).1 It is generally seen in pediatric population and has a distinct male predilection of over 90%. Shields et al.2 classified Coats disease into five stages as follows: Stage 1: presence of retinal telangiectasia only, Stage 2: telangiectasia and exudation (2A: extrafoveal exudation, 2B: foveal exudation), Stage 3: exudative RD (3A: subtotal RD, 3B: total RD), Stage 4: total RD and neovascular glaucoma, Stage 5: advanced end-stage disease.
 Disease progression can be controlled with ablative therapies such as laser photocoagulation (LFK) and cryotherapy in the early stages of Coats disease. However, ablative therapies are not effective in the late stages (Stage 3 – 4) due to excessive subretinal exudation and ERD. Therefore, adjunctive surgical approaches have become popular in the treatment of advanced Coats disease. This helps in effective ablation of leaky abnormal vessels.

Сорбционные свойства суспензионной мази с инкорпорированными природными анионными полисахаридами

Currently, there is a change in methodologies in the treatment of wounds, as a result of which the share of surgical interventions is reduced and new methods of wound care are introduced using dressings and sorption-application therapy of a new generation. The obtained experimental data on the dissolution of the standard hydrophilic ointment base and the commercial ointment Levomekol® in the Ringer-Locke model solution indicate that in real conditions, the ointment will most likely easily dissolve in physiological fluids, quickly absorb and promote the adhesion of the dressing to the wound. The sorption properties of both individual anionic polysaccharides and their mixtures in various ratios in a Ringer-Locke model solution containing the main exudate cations (Na+, K+, Ca2+) were studied in order to assess the prospects of their use as a solid phase in the development of a suspension ointment with sorption properties. This publication presents the results of the behavior of a suspension ointment with anionic hydrocolloids and a commercial ointment Levomecol® in a Ringer-Locke model solution. It is shown that a mixture of sodium alginate and Kappa-carrageenan in a ratio of 1:2 in the developed suspension ointment retained a significant amount of the model solution (24.5 g/g) in its volume for 24 hours. Increasing the sorption capacity of hydrophilic ointments based on PEO will allow you to Sorb excess exudate, create a microclimate to accelerate healing processes, and reduce tissue trauma when removing the dressing.

Noncanonical function of long myosin light chain kinase in increasing ER-PM junctions and augmentation of SOCE.

Increased endothelial permeability leads to excessive exudation of plasma proteins and leukocytes in the interstitium, which characterizes several vascular diseases including acute lung injury. The myosin light chain kinase long (MYLK‐L) isoform is canonically known to regulate the endothelial permeability by phosphorylating myosin light chain (MLC‐P). Compared to the short MYLK isoform, MYLK‐L contains an additional stretch of ~919 amino acid at the N‐terminus of unknown function. We show that thapsigargin and thrombin‐induced SOCE was markedly reduced in Mylk‐L –/– endothelial cells (EC) or MYLK‐L‐depleted human EC. These agonists also failed to increase endothelial permeability in MYLK‐L‐depleted EC and Mylk‐L –/– lungs, thus demonstrating the novel role of MYLK‐L‐induced SOCE in increasing vascular permeability. MYLK‐L augmented SOCE by increasing endoplasmic reticulum (ER)‐plasma membrane (PM) junctions and STIM1 translocation to these junctions. Transduction of N‐MYLK domain (amino acids 1‐919 devoid of catalytic activity) into Mylk‐L –/– EC rescued SOCE to the level seen in control EC in a STIM1‐dependent manner. N‐MYLK‐induced SOCE augmented endothelial permeability without MLC‐P via an actin‐binding motif, DVRGLL. Liposomal‐mediated delivery of N‐MYLK mutant but not ∆DVRGLL‐N‐MYLK mutant in Mylk‐L –/– mice rescued vascular permeability increase in response to endotoxin, indicating that targeting of DVRGLL motif within MYLK‐L may limit SOCE‐induced vascular hyperpermeability.

Periwound skin care considerations for older adults

Samantha Holloway and Kirsty Mahoney discuss the unique ageing effects on adult skin and how these changes can cause the skin to be more prone to damage This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.

Early results of negative pressure wound therapy in treatment of chronic wounds

Abstract Background Chronic wounds may affect only the epidermis and dermis, or they may affect tissues all the way to the fascia. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. Aim of the work to assess the effect of negative pressure wound therapy in management of chronic wound. Patients and Methods This is prospective study was conducted on 30 Egyptian volunteers participated; they were 20 males and 10 females, between the age of 18 and 70 years. This study was conducted from July 2017 to July 2018 at Ain shams university specialized hospitals and Alexandria armed forces hospital. Results VAC therapy, together with periodical surgical wound debridement and specific antibiotic therapy, could be helpful to promote and accelerate wound healing of foot lesions after restoration of an adequate distal blood flow through surgical revascularization or angioplasty. Conclusion Negative-pressure wound therapy (NPWT) devices are designed to apply controlled suction to a wound bed at continuous or intermittent pressure settings to stimulate wound closure. Negative pressure can result in numerous alterations in the wound environment, including removal of excess exudate containing high concentrations of proteases and inflammatory cytokines, stimulation of senescent cells, mobilization of macrophages, and stimulation of angiogenesis.

A novel multilayer hydrogel wound dressing for antibiotic release

In this study, the novel multilayer (ML) hydrogels were developed as antibacterial wound dressings. ML hydrogels were prepared as four layers using carboxylated polyvinyl alcohol (PVA-C), gelatin (G), hyaluronic acid (HA) and gelatin respectively. The upper layers (PVA-C and G) provide the moist control and physical barrier for microorganisms. The HA based middle layer was designed as an antibiotic-loaded layer. The lower layer serves as the controlling membrane for antibiotic release and provides the removal of excess exudate from the wound site. The ML hydrogels were characterized with FT-IR, SEM, DSC, swelling tests and hydrolytic degradation tests. Cell viability assay was also performed in L929 fibroblast cells in vitro. The in-vitro drug release profile of ML hydrogels was investigated at pH 7.4 at 37 °C and it was found that 63% of the antibiotic was released after 7 days.

Evaluation of Pleura Efusion Determination by Light's and Heffner's Cciteria

EVALUATION OF PLEURA EFUSION DETERMINATION BY LIGHT'S DAN HEFFNER'S CRITERIANordjannah1, Ani Kartini2, Darmawaty ER 31 Medical Doctor Specialist Education Programe of Clinical Pathology, Faculty of Medicine Hasanuddin University/dr.Wahidin Sudirohusodo Hospital, Makassar2 Department of Clinical Pathology Faculty of Medicine, Hasanuddin University/ Labuang Baji Hospital Makassar3 Department of Clinical Pathology Faculty of Medicine, Hasanuddin University/ Hospital Islam Faisal Hospital Makassar ABSTRACT Background : Pleural effusion is a condition of abnormal pleural fluid accumulation in the pleural cavity due to excessive transudation or exudation. Light's criteria is used as the standard method to distinguish between exudates and transudates. Some recent studies reported misclassifications so several alternative criteria are developed, one of which is Heffner's criteria. The purpose of this study was to determine the sensitivity and specificity of Heffner's criteria in determining the type of pleural effusion.Methods : An observational study with cross sectional method using a pleural effusion fluid sample of patients examined at the Clinical Pathology Laboratory Instalation at Wahidin Sudirohusodo Hospital on July 2018. Total protein, LDH and cholesterol levels were examined in all samples that met the inclusion and exclusion criteria.Results : There were 45 samples of pleural effusion, 30 of which classified as transudate and 15 samples as exudates. Based on clinical diagnosis, the Light's criteria obtained 3 misclassifications and Heffner's criteria obtained 2 misclassifications. Based on the data above, the statistical data showed that Light's criteria has sensitivity of 96,7 % and specificity of 86,7 %. Heffner's criteria has sensitivity of 100 % and specificity of 86,7 %. Conclusion : Heffner's criteria offers better sensitivity and specificity than Light's criteria. Heffner's criteria can be used as an alternative in determining the type of pleural effusion Keywords: Heffner's criteria, Light's criteria, transudate, exudate, pleural effusion