Wound Infection Research Articles

Inhibitory Effects of Iron Oxide Nanoparticles Biosynthesized by Prodigiosin Pigment Against Clinical Bacteria Isolates of Pseudomonas aeruginosa

The current study aimed to reveal the biosynthesis technique of Fe2O3 nanoparticles by using prodigiosin pigment production from Serratia marcescens. One hundred and twenty samples were obtained from burn and wound infections to isolate Pseudomonas aeruginosa. In addition, the optimum conditions for Fe2O3 nanoparticles biosynthesis were characterized via different methods, including ultraviolet-visible (UV-Vis), atomic force microscope (AFM), fourier transforms infrared (FT-IR) spectroscopy analysis, X-ray diffraction (XRD), and field emission scanning electron microscopy (FE-SEM). In particular, spherical shape particles were observed utilizing FE-SEM technique. In addition, the analysis of AFM revealed Fe2O3 NPs with an average diameter size of 50.73 nm. The influences of varied concentrations of iron nanoparticles (6.25, 12.5, 25 , 50, 100and 200 mg/ml) on a bacterial isolate of Pseudomonas aeruginosa were examined. The maximum inhibition zone of P. aeruginosa was 24 mm at a concentration of 200 mg/ml of Fe2O3 NPs, whereas the minimum inhibition zone were 10 mm located at 25 mg/ml Fe2O3 NPs concentrations.

The comparative study of clinical outcomes among early functional treatment, immobilization treatment and ulnar plate fixation for displaced or comminution fifth metatarsal base fractures

The optimal treatment for displaced or comminution fifth metatarsal base fractures remain debated. Ninety displaced or comminution fifth metatarsal base fractures patients were randomly selected into three groups: the ulnar hook plate fixation group (n=30), the immobilization treatment group (n=18), and the early functional group (n=30). The assessed factors included the duration until union, time to resume daily activities, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, visual analog scale (VAS) ratings and occurrence of complications. The VAS scores showed no significant differences observed among the three treatments. The mean AOFAS score and mean FADI after treatment in the plate group and exhibited significant better than that of the immobilization group and the early functional group at 1 moth, 3 months and 6 months (P˂0.05) . After a duration of 12 months, all three treatments exhibited comparable outcomes and facilitated restoration of daily activities. In the plate group, one patient developed a wound infection, one patient experienced sural nerve injury or irritation, and three patients exhibited implant prominence. One patient encountered nonunion in the immobilization group.The union time and the time of return to daily activities and the early functional group exhibited significant shorter durations than that of the immobilization group and the plate group(P˂0.05). Overall, the early functional treatment is recommended for managing displaced or comminution fifth metatarsal base fractures.Evidences level: III

Cratylia mollis lectin reduces inflammatory burden induced by multidrug-resistant Staphylococcus aureus in diabetic wounds.

In diabetes, tissue repair is impaired, increasing susceptibility to Staphylococcus aureus infections, a pathogen commonly found in wounds. The emergence of S. aureus strains that are highly resistant to antimicrobial agents highlights the urgent need for alternative therapeutic options. One promising candidate is Cramoll (Cratylia mollis seed lectin), known for its immunomodulatory, mitogenic, and healing properties. However, its efficacy in infected diabetic wounds remains unexplored. This study evaluated the effects of topical Cramoll treatment on diabetic wounds infected by S. aureus. Diabetic Swiss mice (induced by streptozotocin) were subjected to an 8-mm wound on the back and subsequently infected with a suspension of multidrug-resistant S. aureus. During the treatment period, the wounds were clinically evaluated for inflammation and the area of injury. After seven days, samples were collected from the wounds to quantify the bacterial load and histopathological and immunological analyses. Wounds infected by S. aureus exhibited more pronounced areas and severity indices, which were significantly reduced by Cramoll treatment (p < 0.05). Histopathological analysis revealed a reduction in inflammatory cells and an increase in revascularization with Cramoll treatment (p < 0.05). Cramoll also promoted greater collagen production compared to controls (p < 0.05). Furthermore, Cramoll treatment significantly reduced the S. aureus load in wounds (p < 0.0001), decreased TNF-α and IL-6 levels in infected wounds, and increased ERK pathway activation (p < 0.05). In conclusion, Cramoll lectin improves the healing of diabetic wounds, and these results contribute to the understanding of Cramoll healing mechanisms, reinforcing its potential as a healing agent in various clinical conditions.

Photo-controlled multifunctional hydrogel for photothermal sterilization and microenvironment amelioration of infected diabetic wounds

Diabetic foot ulcers are linked to a high disability rate, with no effective treatment currently available. Addressing infection, reducing oxidative stress, and safely managing chronic inflammation remain major challenges. In this study, a composite hydrogel dressing was developed using natural substances or clinically approved components (dopamine, D-alpha-tocopheryl polyethylene glycol succinate, and rhein). Upon near-infrared laser irradiation, the composite system rapidly heats and solidifies into a gel with photothermal antibacterial properties. Additionally, the decomposition of hydrogen peroxide releases oxygen, alleviating wound hypoxia. The hydrogel exhibited strong bactericidal activity against multiple bacterial strains. Without laser irradiation, the hydrogel effectively scavenged various free radicals and intracellular reactive oxygen species, restoring redox balance. Furthermore, it significantly reduced the expression of inflammatory cytokines, including interleukin-6 and interleukin-1β. In a diabetic mouse wound model infected with S. aureus, the mild photothermal therapy, combined with the antibacterial action of rhein, effectively managed bacterial infections, reduced inflammation, and promoted wound healing. Consequently, the photo-controlled therapeutic approach, offering antibacterial, antioxidant, and anti-inflammatory effects, holds promise for the effective treatment and management of infected diabetic wounds.

The clinical results and function of the intersegmental disc after posterior-only partial corpectomy for lumbar burst fractures.

We treated the burst spinal fracture with posterior subtotal corpectomy and reconstruction. In some cases, the endplate and the adjacent disc can be preserved during the operation. The adjacent disc retained its mobility after the removal of the posterior pedicle screws. This study evaluated the clinical results and function of the intersegmental caudal disc after the removal of posterior pedicle screws for lumbar burst fractures. The study analyzed retrospectively 36 patients with acute burst traumatic lumbar fractures who underwent posterior partial subtotal corpectomy and reconstruction with preservation of the inferior endplate of the fractured vertebral body and the adjacent caudal disc, and sequential removal of the posterior pedicle screw 1 year after the second surgery from March 2015 to December 2021. All patients were followed for approximately 1 year after pedicle screw removal. Demographic data, anterior vertebral body height, local kyphosis, motion, caudal disc degeneration, and clinical outcomes were evaluated. After removal of the posterior pedicle screws, the intersegmental disc retained a range of motion of 10.55 ± 5.58°, and the disc degeneration was graded by Pfirrmann criteria from 2.21 ± 1.15 before first surgery to 3.18 ± 1.46 at last follow-up after second surgery. There were 2 cases of superficial wound infection, and 5 cases of postoperative neuralgia recovering after 3 months. Anterior fusion was achieved, although postoperative subsidence of the mesh was observed in 6 cases and screw loosening in 9 cases. Posterior-only partial subtotal corpectomy with preservation of the adjacent caudal disc not only achieved a good clinical effect, but also preserved intersegmental caudal disc function after removal of posterior pedicle screws approximately 1 year later. This technique is a promising alternative for cases in which the endplate obviates injury.

Curdlan/xanthan gum-based composite hydrogel with near-infrared irradiation responsive properties for infected wounds healing

Open wounds are prone to bacterial contamination and delayed healing due to environmental exposure, necessitating the development of advanced wound dressings. Hydrogels are ideal candidates for wound care for maintaining a moist environment which benefits for the cell migration and tissue regeneration. However, conventional polysaccharide hydrogels lack intrinsic antibacterial properties, prompting the incorporation of antibacterial agents. Herein, we present a novel composite hydrogel synthesized from curdlan (CUR) and xanthan gum (XG) via thermal annealing, augmented with MXene and Mg2+ to enhance antibacterial efficacy and promote cellular migration. The results proved that the mechanical properties of the composite hydrogel prepared with CUR and XG are significantly enhanced. Due to the influence of near-infrared irradiation, the antibacterial rates of XC/Mg2+/MX against S. aureus and P. aeruginosa are 81.84 % and 89.27 %, respectively. This innovative composite hydrogel offers new insights and avenues in the progress of sophisticated wound healing dressings areas.

Transverse versus longitudinal skin incision in first extensor tendon release for radial styloid tenosynovitis: a randomized controlled trial

BackgroundDe Quervain’s tenosynovitis, characterized by the entrapment of the extensor pollicis brevis and abductor pollicis longus tendons in the first extensor compartment, leads to pain and swelling near the radial styloid. When conservative treatments including rest and antiinflammatory medications fail, surgery is often recommended. This study aimed to compare transverse and longitudinal skin incisions with respect to surgical scars, postoperative pain, and functional outcomes in the open release of the first extensor compartment in radial styloid tenosynovitis.MethodsSeventy patients were randomly assigned to either the transverse or longitudinal skin incision group using a computer-generated random number table. Postoperative scarring was assessed using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Patient-Rated Wrist Evaluation (PRWE) questionnaire at 2, 6, and 12 weeks post-surgery. Continuous data were presented as mean ± standard deviation for normally distributed data or as median (interquartile range) for skewed distributions.ResultsFollowing surgery, both groups showed marked improvements in Thai PRWE and POSAS scores, with no differences in functional outcomes. The longitudinal incision group had significant pain reduction at 2 and 6 weeks post-surgery. By 12 weeks, pain alleviation was similar in both groups. Wound infection was not observed in any case, and three patients reported temporary paresthesia, which was not statistically significant between the groups.ConclusionsBoth techniques demonstrate similar improvements in functional scores and reductions in pain scores, with no significant differences in complication rates, particularly concerning hypertrophic scars. The decision between transverse and longitudinal skin incisions should consider the surgeon’s expertise, the patient’s anatomical characteristics, and the complexity of the surgical procedure. Each approach presents distinct trade-offs, highlighting the necessity of a personalized, patient-centered strategy to optimize surgical outcomes.Trial registrationThe study was registered on 27/06/2023, at clinicaltrials.in.th (TCTR20230627001). This study was retrospectively registered.

Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship

Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship

Use of epigenetically modified bacteriophage and dual beta-lactams to treat a Mycobacterium abscessus sternal wound infection

Nontuberculous mycobacterium (NTM) infections are challenging to manage and are frequently non-responsive to aggressive but poorly-tolerated antibiotic therapies. Immunosuppressed lung transplant patients are susceptible to NTM infections and poor patient outcomes are common. Bacteriophages present an alternative treatment option and are associated with favorable clinical outcomes. Similarly, dual beta-lactam combinations show promise in vitro, but clinical use is sparse. We report here a patient with an uncontrolled Mycobacterium abscessus infection following a bilateral lung transplant and failed antibiotic therapy. Both smooth and rough colony morphotype strains were initially present, but treatment with two phages that kill the rough strain – including epigenetic-modification to overcome restriction – resulted in isolation of only the smooth strain. The rough and smooth strains have similar antibiotic susceptibilities suggesting that the phages specifically eliminated the rough strain. Dual beta-lactam therapy with meropenem and ceftazidime-avibactam provided further clinical improvement, and the phages act synergistically with meropenem in vitro.

A blueprint for broadly effective bacteriophage-antibiotic cocktails against bacterial infections

Bacteriophage (phage) therapy is a promising therapeutic modality for multidrug-resistant bacterial infections, but its application is mainly limited to personalized therapy due to the narrow host range of individual phages. While phage cocktails targeting all possible bacterial receptors could theoretically confer broad coverage, the extensive diversity of bacteria and the complexity of phage-phage interactions render this approach challenging. Here, using screening protocols for identifying “complementarity groups” of phages using non-redundant receptors, we generate effective, broad-range phage cocktails that prevent the emergence of bacterial resistance. We also discover characteristic interactions between phage complementarity groups and particular antibiotic classes, facilitating the prediction of phage-antibiotic as well as phage-phage interactions. Using this strategy, we create three phage-antibiotic cocktails, each demonstrating efficacy against ≥96% of 153 Pseudomonas aeruginosa clinical isolates, including biofilm cultures, and demonstrate comparable efficacy in an in vivo wound infection model. We similarly develop effective Staphylococcus aureus phage-antibiotic cocktails and demonstrate their utility of combined cocktails against polymicrobial (mixed P. aeruginosa/S. aureus) cultures, highlighting the broad applicability of this approach. These studies establish a blueprint for the development of effective, broad-spectrum phage-antibiotic cocktails, paving the way for off-the-shelf phage-based therapeutics to combat multidrug-resistant bacterial infections.

LIMITED USE VERSUS TOTAL USE OF TOURNIQUET IN PRIMARY TOTAL KNEE ARTHROPLASTY

Background: Tourniquets are used during total knee arthroplasty for better surgical fields and improved cementation. The functional benefits of tourniquet application for limited periods compared with total duration applications during total knee joint arthroplasty (TKA) surgery have not been well explored. Aim of the study: To evaluate and compare the outcomes of limited use of a tourniquet (LT) for a shorter duration (just before cement application) with total use of a tourniquet (TT) for a longer duration (from skin incision to the completion of surgery). Patients and method: A sum of 100 patients who undertook primary total knee arthroplasty were involved in this study, they were allocated randomly into two groups according to whether a limited or total tourniquet was used during the surgery. Both groups underwent the same surgical procedures with a digital tourniquet applied to all patients using the same technique. Intraoperative and postoperative assessment of blood loss, knee functional society score (KSS), visual analogue score (VAS) for thigh pain and knee pain evaluation, surgical complications like deep vein thrombosis (DVT), wound infections and nerve injuries are the main factors evaluated in the study. Results: Patients with LT required more intraoperative blood transfusion compared with those with TT who required more blood transfusion postoperatively. There were no significant differences in KSS, VAS for thigh pain and knee pain evaluation, and surgical complications like DVT, wound infections and nerve injuries. Conclusion: Limited tourniquet application from starting of cementing is associated with a higher need for intraoperative blood transfusion, but the use of a TT throughout surgery is associated with a higher need for postoperative blood transfusion.

Association Between Postoperative Lymphocyte Count and the Occurrence of Infections After Pediatric Cardiac Surgery With Cardiopulmonary Bypass.

The objective of this study was to evaluate the association between the minimal count of lymphocyte (Ly_Min) after cardiac surgery with cardiopulmonary bypass and the occurrence of infections within the first 30 postoperative days (POD). From a local European Congenital Heart Surgeons Association (ECHSA) database, all cardiac surgeries with cardiopulmonary bypass in children under 18 years old between January 2014 and December 2021 were eligible. Infections occurring within 30 POD were prospectively recorded according to ECHSA definitions, and classified into sepsis, pneumonia, wound infection, mediastinitis or endocarditis. For each surgery, Ly_Min was collected during the first 2 POD and the optimal threshold for predicting infection was chosen using receiver operating characteristic curve analysis. Univariate and multivariate logistic regression analyses were performed to identify variables associated with the risk of infection. Of 1428 surgeries conducted over the 8-year period, 111 (8%) were complicated by at least 1 infection, including pneumonia (n = 45), wound infection (n = 41), sepsis (n = 24), mediastinitis (n = 20) and endocarditis (n = 3). Mean Ly_Min in the first 2 POD was lower in the infected group compared with the noninfected group (1.32 ± 0.81 vs. 1.81 ± 1.05 × 109/L, P < 0.001). After adjusting for confounders, Ly_Min <1.105 × 109/L within the first 1 POD was independently associated with an increased risk of postoperative infections (adjusted odds ratio = 1.75, 95% confidence interval: 1.10-2.79, P = 0.019). In this large single-center cohort of pediatric cardiac surgeries, Ly_Min during the first 2 POD was associated with the development of infections within 30 days after cardiopulmonary bypass.

Clinical management of chronic wound infections: The battle against biofilm.

Bacteria constitute the most abundant life form on earth, of which the majority exist in a protective biofilm state. Since the 1980s, we have learned much about the role of biofilm in human chronic infections, with associated global healthcare costs recently estimated at ~$386 billion. Chronic wound infection is a prominent biofilm-induced condition that is characterised by persistent inflammation and associated host tissue destruction, and clinical signs that are distinct from signs of acute wound infection. Biofilm also enables greater tolerance to antimicrobial agents in chronic wound infections compared with acute wound infections. Given the difficulty in eliminating wound biofilm, a multi-targeted strategy (namely biofilm-based wound care) involving debridement and antimicrobial therapies were introduced and have been practiced since the early 2000s. More recently, acknowledgement of the speed at which biofilm can develop and hence quickly interfere with wound healing has highlighted the need for an early anti-biofilm strategy to combat biofilm before it takes control and prevents wound healing. This strategy, referred to as wound hygiene, involves multiple tools in combination (debridement, cleansing, and antimicrobial dressings) to maximise success in biofilm removal and encourage wound healing. This review is intended to highlight the issues and challenges associated with biofilm-induced chronic infections, and specifically address the challenges in chronic wound management, and tools required to combat biofilm and encourage wound healing.

A chondroitin sulfate-based temperature-responsive hydrogel with antimicrobial properties for epidermal wound repair in diabetic patients

Preventing wound infection and avoiding secondary damage to wounds during dressing changes represents a significant clinical challenge. Developing wound dressings that mitigate wound infections and facilitate peel-on-demand property may solve the problem. In this study, a temperature-responsive hydrogel with antimicrobial and on-demand peeling properties was proposed. Basing on the Schiff-base reaction, a gelatin/oxidized chondroitin sulfate (GelOCS@Ag) hydrogel loaded with silver nanoparticles was synthesized via the straightforward amalgamation of gelatin, chondroitin sulfate, and silver nanoparticles. The resultant hydrogel exhibited commendable tensile, recovery, and temperature-responsive properties, effectively reconciling the dichotomy between adhesion and reversible adhesion, and thereby achieving the desired effect of on-demand peeling. Specifically, the adhesion strength of the GelOCS@Ag hydrogel reached 12.7 kPa at body temperature, in stark contrast to a mere 1.2 kPa at 10℃, facilitating easy detachment from the wound surface. Furthermore, the hydrogel exhibited potent antimicrobial properties and demonstrated excellent cytocompatibility. The GelOCS@Ag hydrogel has promising applications within the realm of wound dressings.

BaTiO3 Doping Enhances Ultrasound-Driven Piezoelectric Bactericidal Effects of Fibrous Poly(L-Lactic Acid) Dressings to Accelerate Septic Wound Healing.

Bacterial invasion in infected skin wounds triggers inflammation and impedes healing. Current therapeutic strategies incorporating drug interventions within wound dressings often result in drug resistance and delayed healing. Here, we developed a comprehensive therapeutic modality integrating piezoelectric fibrous dressing with controlled ultrasound stimulation for efficient healing in an infected wound model. The electrospun fibrous dressings composed of barium titanate (BaTiO3) doped poly(L-lactic acid) (PLLA) possess improved piezoelectric properties due to the aligned structure and high crystallinity, which achieved superior bactericidal efficacy upon ultrasound-mechanical-electric conversion that results in the production of reactive oxygen species (ROS). There were 88.72% and 90.43% killing rates of Staphylococcus aureus and Escherichia coli respectively upon ultrasound stimulation without any need for exogenous drugs, and a wound closure rate of 95.5% within 10 days. The in vivo results confirmed that this dressing effectively shortened wound closure time by about 2 days, with a much-improved healing rate of 14% compared with previously reported therapeutic strategies. This was accompanied by reduced inflammation and increased re-epithelialization and angiogenesis. Hence, our synergistic treatment by piezoelectric materials and controlled ultrasound stimulation provides a drug-free alternative approach in regenerative tissue engineering for simultaneously enhancing antibacterial effects and promoting wound healing.

Removing hardware from anterior approaches following acetabular fractures: a challenging yet indicated procedure.

To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures. Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)). The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results. Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.

Uniportal Robotic Lobectomy and Lymphadenectomy for Invasive Lung Cancer: A Novel Approach and Perioperative Outcomes.

Multiport robot-assisted thoracoscopic surgery (mRATS) has been comprehensively evaluated for its clinical efficacy in numerous studies. Nevertheless, the safety and feasibility of uniportal robotic lobectomy and lymphadenectomy require further validation. The clinical data of 34 consecutive patients with lung cancer who underwent improved uniportal robotic-assisted thoracoscopic surgery (uRATS) at our hospital between November 2023 and June 2024 were reviewed retrospectively. Camera-centered uRATS was conducted using the da Vinci Surgical Xi system (Intuitive Surgical Inc., 1266 Kifer Road, Sunnyvale, CA 94086, USA). Descriptive statistics are expressed as numbers with percentages for categorical data or medians (ranges) or means with standard deviations for continuous data. Improved uRATS lobectomy and lymphadenectomy were conducted in 34 patients with postoperative pathology-diagnosed invasive lung cancer. Among the patients, the median number of lymph nodes dissected was 24.5 (range 10-42), and the median number of stations with lymph nodes dissected was 8 (range 6-11). The median durations of the operation and the uRATS procedure were 200 min (range, 142-330 min) and 140 min (range, 80-242 min), and the median intraoperative blood loss volume was 20 mL (range, 10-100 mL), respectively. All postoperative complications, including pneumonia (2/34, 5.8%), air leakage > 5 days (2/34, 5.8%), prolonged wound healing (1/34, 2.9%), and arrhythmia (1/34, 2.9%), were graded as Clavien-Dindo grades I-II. There were no cases of wound infection or postoperative 30-day mortality. The safety and feasibility of uRATS lobectomy and lymphadenectomy using the da Vinci Surgical Xi system have been preliminarily validated.

Incidence and risk factor of blood transfusion after abdominal radical hysterectomy for cervical cancer: a 10-year retrospective study of the US nationwide inpatient sample.

With the rising prevalence of abdominal radical hysterectomy, the need for perioperative blood transfusion has emerged as a significant clinical challenge. Independent risk factors for blood transfusion during abdominal radical hysterectomy remains limited, and identifying these factors is needed. A retrospective analysis of data was performed using the Nationwide Inpatient Sample (NIS), focusing on patients who underwent abdominal radical hysterectomy between 2010 and 2019. Patients were categorized into two groups based on whether they received a blood transfusion. The analysis encompassed various demographic factors, including race, sex, and age, as well as length of stay (LOS), total hospitalization charges, hospital characteristics (admission type, insurance type, bed size, teaching status, geographic location, and hospital region), hospital mortality rates, comorbidities, and perioperative complications. Subsequently, both univariate and multivariate logistic regression analyses were employed to ascertain factors associated with abdominal radical hysterectomy patients requiring blood transfusions. Blood transfusions occurred in 14.84% of patients between 2010 and 2019, with a downward trend over time. Receiving a transfusion was associated with several negative outcomes, including a longer length of stay, higher total charges, and complications like thrombocytopenia, acute myocardial infarction, pneumonia, and so on. Additionally, patients who received transfusions were more likely to experience postoperative delirium, deep vein thrombosis, and wound infection. Independent risk factors for blood transfusion include Black race, Asian or Pacific Islander race, non-elective surgery, hospitalization in a rural setting, pre-existing medical conditions like coagulopathy, chronic blood loss anemia, deficiency anemia and others. Conversely, patients with private insurance, residing in the West, or Midwest/North Central regions were less likely to require a blood transfusion. Our study highlights the concern of perioperative blood transfusion in radical hysterectomy, linked to significant complications. Reducing intraoperative blood loss and optimizing care based on patient factors are crucial for improving outcomes.

Efficacy of Agnikarma (Cauterization) in the Management of Mashaka (Elevated Mole): A Case Study

Introduction A mole or naevus is a lesion that can exist from birth. While some moles are present at birth, others become apparent later in life. The two main symptoms associated with moles are black spots and potential disfigurement. In Ayurveda, an elevated mole is comparable to a condition known as Mashaka. Mashaka is described as a firm, painless, black, and raised eruption on the skin, typically caused by an aggravated Vata Dosha (humor). Modern medical practice commonly manages moles through surgical excision and radioactive procedures to prevent potential malignancy or aesthetic concerns. However, in the Ayurvedic tradition, Mashaka is treated using the Agnikarma (cauterization) procedure. This approach is efficient as it soothes the Vata-Kapha Doshas (humors). Materials and Methods Agnikarma (cauterization) is a minor surgical treatment that involves the application of heat ( Agni) for therapeutic purposes aimed at reducing and eliminating the lesion. In this case study, a patient complained of a lesion on the right side of the nose. The lesion was diagnosed as Mashaka based on the ABCDE criteria for melanoma assessment, which considers Asymmetry, Border irregularity, Color variation, Diameter, and Evolution of the lesion. An Agnikarma procedure (cauterization) was carried out in a single sitting for this lesion. Results After four weeks, the lesion had healed without complaints of bleeding, wound infection, pain, or scarring. Discussion The case study demonstrates the efficacy of Agnikarma (cauterization), highlighting its scope as a treatment option for similar conditions, providing a safe and satisfactory outcome for the patient.

Microneedles Constructed by Swellable Hydrogels Loaded with Celastrol for Efficient Treatment of Skin Infections Induced by Drug-Resistant Bacterial Strains.

The urgent need for new antimicrobial drugs arises from the limited efficacy of traditional antibiotics against emerging drug-resistant strains. Celastrol (CSL) demonstrates an exceptional antibacterial property that remains unaffected by bacterial resistance, but its poor water solubility limits its wide applications. This study uses the hydrophobic inner cavity of mono-(6-diethylenetriamine-6-deoxy)-β-cyclodextrin (mβ-CD) (a derivative of cyclodextrin) to encapsulate CSL, constructing an inclusion complex (CSL@mβ-CD) to enhance the water solubility of CSL. The obtained inclusion complex is further incorporated into a swellable hydrogel microneedle (MN) to obtain CSL@mβ-CD/MN. The fabricated CSL@mβ-CD/MN can enable the sustained release of CSL, achieving effective bacterial eradication at infected sites. In vivo experiments demonstrate that CSL@mβ-CD/MN has a remarkable efficacy in the treatment of methicillin-resistant Staphylococcus aureus-induced subcutaneous abscesses and wound infections. Specifically, CSL@mβ-CD/MN can effectively penetrate the stratum corneum of the skin to realize rapid elimination of the bacteria in wounds. Moreover, CSL@mβ-CD/MN can efficiently scavenge reactive oxygen species, promote M2 polarization of macrophages, and relieve local inflammation at the wound sites. These results reveal that CSL@mβ-CD/MN holds great promise in the clinical treatment of acute skin infections induced by drug-resistant bacteria.