Lower Skin Research Articles

Biodegradable and dissolvable resveratrol nanocrystals non-silicon microneedles for transdermal drug delivery

The prevalence and lethality of cutaneous melanoma have increased in recent years. Lower skin penetration rates and poor soluble affect the effective delivery of resveratrol. To overcome these two issues, a biodegradable and dissolvable resveratrol nanocrystals non-silicon microneedles was designed in this study. The nanocrystals technology was used to improve the resveratrol solubility. Transmission electron microscopy and scanning electron microscopy demonstrated that the amorphous resveratrol nanocrystals were successfully prepared with a particle size of 161 ± 9 nm and presented a superior performance in vitro dissolution of 84.14 ± 2.53% for 120 min. For the skin permeability issue, a dissolvable microneedle, made with a biocompatible and biodegradable polymer (a mixture of polyvinylpyrrolidone and polyvinyl alcohol), exhibited exceptional mechanical strength even the microneedles matrix was loaded with the drug for 1.26 N/needle. The z-axis scanning also exhibited the uniformity of rhodamine B within the needle. And it presented rapid resveratrol releases after puncture into the mice's skin. The dissolvable microneedles loaded with the resveratrol nanocrystals provided an efficient and convenient transdermal delivery system.

Prevalence of healthcare-associated infections in Dutch long-term care facilities from 2009 to 2019

We assessed trends in the prevalence of healthcare-associated infections (HCAI) and associated resident and facility characteristics in a national network of long-term care facilities (LTCFs) in the Netherlands in 2009-2019. Participating LTCFs registered the prevalence of urinary tract infection (UTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), bacterial conjunctivitis, sepsis and skin infection, using standardized definitions, in biannual point-prevalence surveys (PPS). In addition, resident and LTCF characteristics were collected. Multilevel analyses were performed to study changes in the HCAI prevalence over time and to identify resident and LTCF-related risk factors. Analyses were performed for HCAI overall and for UTI, LRTI and GI combined as these were recorded throughout the period. Overall, 1353 HCAIs were registered in 44,551 residents with a prevalence of 3.0% (95% confidence interval: 2.8-3.1; range between years 2.3%-5.1%). When including only UTI, LRTI and GI the prevalence decreased from 5.0% in 2009 to 2.1% in 2019. Multivariable regression analyses for UTI, LRTI and GI combined indicated that both prolonged participation and calendar time were independently associated with HCAI prevalence; in LTCFs that participated ≥ 4 years, the HCAI risk was decreased (OR 0.72 [0.57-0.92]) compared with the first year, and the OR per calendar year was 0.93 [0.88-0.97]. Over eleven years of PPS in LTCFs the HCAI prevalence decreased over time. Prolonged participation further reduced the HCAI prevalence, in particular UTI, despite the increasing age and associated frailty of the LTCF population, illustrating the potential value of surveillance.

The effect of Salix alba L. bark extract on dark circles in vitro and in vivo.

Dark circles in the infraorbital area are a common cosmetic concern among individuals because they exhibit fatigue and are undesirable across all ages. Of the dark circle etiologies, blood stasis by poor vascular integrity can cause darkening of the lower eyelid skin, which might be alleviated by reduced endothelial permeability. In this study, we investigated the effects of Salix alba bark extract (SABE) on the synthesis of hyaluronic acid (HA) in fibroblasts and vascular integrity protection from inflammatory cytokine. We also performed a clinical trial investigating the effect of SABE on dark circles. To confirm the effect of SABE on HA synthesis in human dermal fibroblasts (HDF), we performed ELISA and real-time PCR. We investigated interaction HDF-secreted substance with vascular integrity, and human dermal microvascular endothelial cells (HMEC-1) were treated with conditioned medium (CM) from HDF treated with or without SABE. Subsequently, we conducted a clinical study on 29 subjects by having them apply SABE containing cream for 8 weeks. SABE treatment increased HA synthesis and regulated HMW-HA related gene expressions in HDF. CM from SABE-treated HDF alleviated endothelial permeability and led to improved vascular integrity in HMEC-1 cells. Treatment with the cream containing 2% SABE for 8 weeks improved the parameters measuring dark circles, skin microcirculation, and elasticity. Our results showed that SABE could protect against dark circles in vitro, and that topical treatment of SABE improved the clinical indexes of dark circles in a clinical study. Therefore, SABE can be used as an active ingredient for improving dark circles.

Heat transfer analysis of a hybrid nanofluid flow on a rotating disk considering thermal radiation effects

This study investigates heat transfer in a hybrid nanofluid that flows due to a rotating disk. The nanofluid contains copper and dioxide nanoparticles in water and is affected by a constant magnetic field. The study accounts for heat generation/absorption and thermal radiation and solves the governing equations using similarity transformations and the Shooting Method. The research reveals that the higher nanoparticle concentration in a fluid result in increased radial and azimuthal velocities due to improved convective heat transfer. This leads to higher fluid velocity and lower local skin friction coefficient. Heat generation/absorption and thermal radiation have a strong influence on the heat transfer process. Higher nanoparticle concentration, variable thermal conductivity parameter, and radiation parameter cause an increase in the temperature of the hybrid nanofluid. The local Nusselt number increases with an increase in the variable thermal conductivity parameter but decreases with nanoparticle concentration while increases with the thermal radiation parameter. Results from a special case analysis, which excluded certain parameters, closely agree with previous studies, confirming the validity of the solution. These findings can be useful in understanding heat transfer in similar scenarios, especially in energy engineering and thermal management.

Investigation of materials for palm and dorsal of anti-vibration gloves for thermal comfort

The thermal comfort of a work glove affects wear compliance. This study investigates the thermal comfort of five types of anti-vibration gloves that use chloroprene rubber and spacer fabric as materials to isolate vibration. An evaluation of the fabric and material on the palm and dorsal of the glove, and a wear trial of the gloves were subsequently carried out. The results showed that the palm of the glove made of spacer fabric had higher air and water vapour permeabilities than chloroprene rubber. Using a thin mesh fabric for the dorsal of the glove resulted in a significantly lower skin temperature than using spacer fabric or chloroprene rubber during hand activity. The thermal sensation of the subjects showed no significant difference among the five glove samples. However, the glove wear comfort of the spacer fabric glove was the lowest. Recommendations for the fabric thickness and glove design are provided for developing anti-vibration gloves.

Comparison of skin carotenoid content scores and dietary intake between cognitively normal older adults and older adults with Alzheimer’s Disease: A matched‐pair analysis

AbstractBackgroundAlzheimer’s Disease (AD) is a systemic metabolic disease with a variable number and type of clinical symptoms mostly impacting the brain. Skin carotenoid content (SCC) is an objective measure of carotenoid‐containing fruit and vegetable intake that has been validated in diverse populations. Our previous findings suggest SCC scores are impacted by various metabolic disease states. Therefore, our objective was to analyze SCC scores and dietary intake across matched pairs including unimpaired adults and those with AD.MethodBaseline data from two dietary interventions (NCT03860792, NCT03841539) were analyzed. Pairs are exact matches for sex, race/ethnicity, and education and are matched within two years of age and 4 kg/m2 body mass index. Each pair (n = 12 pairs) includes one cognitively normal (MMSE > 25), community dwelling older adult (‘CN’) and one community dwelling older adult with AD (‘AD’). Baseline self‐reported dietary intake data (3‐day food records) were collected, reviewed, and entered into the Nutrition Data System for Research (NDSR 2019) database by a Registered Dietitian. SCC scores were collected through pressure‐mediated reflection spectroscopy via VeggieMeter® (Longevity Link Corporation, Holladay, UT). Two‐sample independent t‐tests assuming unequal variances were used to compare differences in SCC scores and dietary intake. Significance was set at p = 0.05.ResultThere was a significant difference in SCC scores between matched pairs (SCC scores: CN 284.25, AD 207.67, p = 0.008). There was no difference between pairs for total daily energy (kcal/day; p = 0.60), fat (g/day; p = 0.91), carbohydrate (g/day; p = 0.85), or protein (g/day; p = 0.26) intake. Both groups had similar food group intake (p‐value range 0.09‐0.79), including all fruit and vegetable groups except CN had higher intake of non‐citrus fruit (p = 0.046). Total fruit (p = 0.09) and fruit plus vegetable (p = 0.24) were not different between pairs. Dietary intake by individual carotenoid was not significantly different (total vitamin A, p = 0.48; beta‐carotene, p = 0.49; alpha‐carotene, p = 0.57; beta‐cryptoxanthin, p = 0.60; lutein plus zeaxanthin, p = 0.07; lycopene, p = 0.37).ConclusionIndividuals with AD have lower carotenoid skin content compared to matched cognitively unimpaired individuals. These differences are not explained by differences in diet suggesting that AD may be associated with disease‐associated biochemical features that are metabolism‐related and not limited to the brain.

Assessment and Treatment Strategies for the Aesthetic Improvement of the Lower Face and Neck.

Interest in aesthetic rejuvenation of the lower face and neck is growing, but published expert guidance is limited. Review aesthetic concerns of the lower face and neck and provide expert guidance on evaluation and treatment. Twelve international experts participated in an advisory board on lower face and neck aesthetic treatment. They completed a premeeting survey and met twice, reviewing responses and discussing patient evaluation and treatment strategies. They developed decision tree algorithms on patient assessment and treatment planning and sequencing, using clinical cases as a reference. Treatment concerns include neck and lower face skin laxity, structural bone deficiency, insufficient or excess volume, submental fat, jowls, platysma bands, and masseter muscle prominence. Advisors agreed that the lower face and neck may be the most challenging areas to assess and treat; treatment goals include lower facial contour and overall facial harmony/balance. Advisors recommended first ruling out a surgical approach, then determining whether midface treatment is needed to support the lower face, and lastly evaluating the lower face for significant submental fat, excess or insufficient volume, and structural bone deficiency. To treat the lower face and neck, an anatomical layer approach, moving from deep to superficial layers, beginning with structural support, was recommended. Assessment and treatment decision trees were based on this approach. The lower face and neck are important but underrecognized areas of aesthetic concern. This article provides expert guidance and a suggested algorithm for assessment and treatment aimed at achieving satisfying and harmonious facial aesthetic results.

Application of a thermo-physiological model to determine sweating thermo-active zone for a medical staff subject

Thermo-physiological models represent a valid approach for the study of person-environment energy interactions and constitute an alternative and promising methodology for the study of comfort in all those cases in which the Fanger’s statistical model is not applicable. By dividing the body into several segments, and these into several nodes, including physiological variables among the inputs and detailing the representation of clothing, these models are better suited to application in the healthcare sector, as they can take into account pathological states that alter physiological responses (patients) and specific types of clothing and activities (medical staff). In this work, the Tanabe 65 MN model, implemented in the ABICS opensource software, has been used to identify the thermo-active zones in which sweating occurs on at least one section of the body for a person of the medical staff. A parametric analysis was developed by varying the ambient temperature (20 - 36 °C), the relative humidity (40 - 60%), the metabolic rate (1.5 - 2.0 met) and considering a young subject (30 years) and an older one (60 years). These zones were identified on charts correlating the skin temperature to the ambient one. In both cases, a similar trend is observed: the average temperature of the skin, at which sweating occurs, increases as the ambient temperature grows and on average this mechanism is activated for lower skin temperatures in the case of the older individual.

Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis

To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis. The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy. There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up. Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Development of Air Ventilation Garments with Small Fan Panels to Improve Thermal Comfort

Air ventilation garments (AVGs) are reported to be effective in improving thermal comfort in hot environments in previous research. The purpose of this study was to develop AVGs with small fan panels and examine their cooling performance. Three AVGs equipped with more, much smaller sized ventilation fans were developed, including FFV (ten small fans all located on the front body), BBV (ten small fans all located on the back body), and FBV (six small fans located on the front body and four small fans located on the back body). Another garment, without ventilation fans but with the same structure and textile material, was made as a reference garment (CON). The cooling performance of the four garments was examined through subject trials in a moderately hot environment of 32 °C and 60% relative humidity. Simulated office work with 70 min of sedentary activity was performed. The results showed that the physiological indexes of the mean body skin temperature, the mean torso skin temperature, and the heart rate in the three AVG scenarios were significantly lower than those in the CON condition (p &lt; 0.05). Thermal sensation, thermal comfort, and wetness sensation were also improved when wearing the three AVGs (p &lt; 0.05). No significant difference was displayed among the three AVGs on the whole body and the whole torso (p &gt; 0.05) due to the similarity of the air velocity created by the fan panels. A significant difference was found on the local torso skin, with FFV significantly reducing the chest and the belly skin temperature, and BBV significantly reducing the scapula and the lower back skin temperature (p &lt; 0.05). This study indicates that the AVGs with the small fan panels were effective in reducing heat strain and improving thermal comfort, and thus are recommended for use in hot environments.

SPOROTRICHOSIS IN CHILDREN: A FORGOTTEN ENTITY

Sporotrichosis is regarded as the most common subcutaneous fungal mycosis, which occurs following traumatic inoculation of Sporothrix schenckii complex. Albeit rare, sporotrichosis, also known as 'rose gardener's disease', has been reported to involve children whereby active or passive transmission through a vector such as domestic animals has been identified as the main culprit. Herein, we report sporotrichosis in a pair of siblings who presented to the outpatient Otorhinolaryngology clinic in University Malaya Medical Centre with a lower lips skin lesion and submental swelling after kissing their domestic cat. Sporotrichosis was diagnosed following the fungal culture of the skin scrapings of the lower lip’s pustular lesions. Prompt treatment with oral itraconazole (8 mg/kg/day) for six weeks showed the resolution of symptoms. We highlight the pathophysiology of zoonotic sporotrichosis and the mode of management of this entity. Additionally, the management of sporotrichosis should include the veterinarian's assessment of the infected animal.

Adult female with a painful and pruritic lower extremity skin lesion.

Adult female with a painful and pruritic lower extremity skin lesion.

Comparison of In-service Reduced vs. Full Torso Coverage Armor for Females.

Body armor and torso-borne equipment are critical to the survivability and operational effectiveness of a soldier. Historically, in-service designs have been predominantly designed for males or unisex, which may be disadvantageous for females who are shaped differently and, on average, smaller in stature and mass than their male counterparts. This study assesses the biomechanical and performance impact of two Canadian in-service armors and fighting load conditions on females. Four tasks (i.e., range of motion, treadmill march [×2], and a wall obstacle) were performed in a Baseline condition and two in-service torso-borne equipment conditions; the full torso coverage (FTC) condition has full upper torso soft armor with the fighting load carried in a separate vest, while the reduced coverage (RC) has a plate carrier with fighting load integrated into the armor carrier, bulk positioned higher, and less torso coverage. Both used identical combat loads and front and back armor plates. Trunk range of motion, march lower limb kinematics, march shoulder and hip skin pressures, perceived discomfort after the march, and time to traverse a wall obstacle were captured. Data were collected to assess the biomechanics and usability of the systems for eight females, representative of military recruits. Linear mixed-effects models were created, and analysis of variances (ANOVAs) were then performed on all the outcome measures (P < .05). Tukey's post-hoc procedures were performed when appropriate (P < .05). There were significant differences between the RC and FTC for the sit and reach test (P < .001), lateral bend test (P < .001), and wall traverse time (P < .01). In all cases, the RC outperformed FTC. There were no differences between the two in-service conditions with respect to hip, knee, and ankle flexion/extension. The RC average skin pressure was higher than the FTC at the left and right shoulders by 103% and 79%, respectively, and peak skin pressure at the left shoulder by 75%. Both in-service conditions showed decrements in performance from Baseline for sit and reach (P < .001), lateral bend (P < .001), and peak hip and knee flexion (P < .01) with the FTC showing decreases in trunk rotation (P < .001) and wall traverse time (P < .01). Improved outcomes for the RC can be attributed to design differences. The lower placement of bulk in FTC may act as a physical barrier during range of motion tasks and the wall obstacle. The presence of shoulder caps on FTC provides another physical barrier that likely impedes full movement through the arms and shoulders. While the narrower shoulder straps of the RC remove the barrier, it causes more concentrated skin pressures on the shoulder that can lead to injury. The results suggest that the RC offers a potential for increased operational effectiveness in females (and potentially for males) compared to the FTC system. Shoulder pressure, an important predictor of discomfort and injury, is the only measure for which FTC outperformed the RC. Future torso-borne equipment designs targeting this outcome measure could help increase the effectiveness of the RC and other similar systems that reduce torso coverage, though survivability implications must also be considered.

51 Relationship of Early Dressing Change, Ambulation, and Early Discharge in Lower Extremity Grafted Burn Wounds

Abstract Introduction Split-thickness skin graft (STSG) healing follows the imbibition, inoculation, and revascularization healing model. The stage of imbibition takes approximately 48-72 hours and requires direct contact with the wound for success. Prior to revascularization the graft is at increased risk for damage from shear stress. Many of the protocols in place are based on pathophysiology of wound healing and few published data exist on the timing and logistics of mobilization after lower extremity STSG for burns. There is discordance in the Burn community as to when it is safe to start ambulation with patients after lower extremity skin grafting. The timing of the first dressing change may accelerate or delay ambulation and increase time to hospital discharge. Methods Retrospective chart review of burn patients regardless of age, admitted to burn service with grafted burns to lower extremities, whether they had other concomitant burns with/without grafting to determine if earlier first postoperative dressing changes (≤ 3 days) to grafted lower extremity burns lead to earlier ambulation and shorter hospital stays. Secondary endpoints will be evaluation of the ideal time to change the dressing after initial STSG grafting of the lower extremity without increasing graft failure rates. Results The groups were even in time from surgery to 1st dressing change (1st DC) (167 had a 1st DC in ≤3 days post-op, and 163 had a 1st DC &amp;gt;3 days post-op). Demographics and medical history were nearly identical between the two groups, indicating there may be no association between the demographics or medical history collected and earlier dressing change. Median time from surgery to the 1st DC was 3 days (IQR: 3-5) in the entire sample, and from surgery to staple removal was 5 days (IQR: 4-6). The median length of hospital stay in the entire sample was 10 days, and this slightly differed between groups: those with a 1st DC of ≤3 days had a shorter hospital stay (9 days [IQR: 6-13]) than those with a 1st DC of &amp;gt;3 days (11 days [IQR: 7-16]), this is exemplified in Figure 2. 80.3% of patients were discharged home in the sample, with a greater proportion of patients discharged to a facility when they had a 1st DC &amp;gt;3 days post-op (24.5%) than if they had a 1st DC ≤3 days post-op (15%). A greater proportion of patients were discharged walking (47.6% vs 32.7%) when they had an earlier 1st DC than those who did not. Graft failure was seen in 6 patients with 5 of them needing re-STSG. Four due to graft loss and two due to cellulitis. Conclusions Patients who had 1st DC ≤ 3 days after surgery saw an earlier hospital discharge by 2 days without risk of graft loss due to hematoma or seroma regardless of comorbidities. Applicability of Research to Practice The data gathered will be used to establish a clinical based approach to lower extremity dressing changes. We hope to delineate a timeline based on tailored patient factors that can be used as guideline to safely expedite ambulation and minimize hospital stays without increasing graft failure rates.

Effects of group size and cage enrichment on social behaviour and skin injuries of breeding rabbits housed part-time in group

Housing of breeding does in group pens can result in skin injuries and stress due to maternal protective behaviour and hierarchy fights. Aggression can be partly reduced by using single-litter cages during the first weeks of the reproductive cycle and by delaying the grouping of does with their litters until the kits are older. Hierarchy fights do still occur in these part-time housing systems, however. The present study evaluated the effect of group size and cage enrichment on doe and kit skin injuries and on doe social behaviour. During four cycles, groups of either three or four does with their 22-day-old kits were housed in group pens for 13 days. Pens were assigned one of the following treatments (n = 12 pens per treatment): group of four does with no additional enrichment, four does with additional cage enrichment, three does with no additional enrichment and three does with additional cage enrichment. Cage enrichment was comprised of plastic pipes and elevated platforms. As pen size remained constant, a change in group size also implied a proportional change in stocking density. The number and severity of skin injuries were monitored before grouping and at 1, 3, 6, 9 and 13 days after grouping. Video recordings from all group pens were scored continuously for doe behaviour during the first 24 h after grouping in the first and second reproduction cycle and for the first 8 h in the third cycle. Four severely injured does needed to be removed after grouping. During the first day after group housing, respectively, 72.6 and 13.0% of the does and kits acquired at least one new skin injury with respect to the onset of group housing. Compared with groups of four, does in groups of three had lower averaged skin injury scores (9.41 versus 8.40, P = 0.004). Of all observed postgrouping social behaviours, submissive behaviour was most frequently observed (42.8%), followed by aggressive behaviour (29.8%), engaging behaviour (25.1%) and non-aggressive social contact (2.3%). Does used the enrichment during 11.1% of the total observation time, during which the platforms were more frequently visited (97.2%) in comparison to the plastic pipes (2.8%). As shown by the percentage of injured animals on the last day of grouping (does: 61.9% and kits: 18.4%), postgrouping aggression remains a problem that appears difficult to reduce to acceptable levels by reducing group size (and stocking density) or by providing cage enrichment.

Cooling vest improves surgeons’ thermal comfort without affecting cognitive performance: a randomised cross-over trial

ObjectivesSurgeons become uncomfortable while performing surgery because heat transfer and evaporative cooling are restricted by insulating surgical gowns. Consequently, perceptions of thermal discomfort during surgery may impair cognitive performance. We,...

Clinical manifestations, treatment and outcomes of patients infected with Mycobacterium haemophilum with a focus on immune reconstitution inflammatory syndrome: a retrospective multi-site study

Background Mycobacterium haemophilum is a nontuberculous mycobacterium with fastidious in vitro growth requirements and an increasingly reported cause of extrapulmonary disease. Timely diagnosis and management of M. haemophilum infections and the immune reconstitution inflammatory syndromes (IRIS) observed in a subset of patients during treatment remain challenging. Methods We conducted a retrospective chart review between January 1, 2010, and January 1, 2022 and identified 26 patients diagnosed with M. haemophilum infection at our institution. We describe their clinical presentation, diagnostic results, management, and outcomes. Results The majority of patients in our cohort had upper and/or lower extremity skin involvement, were immunosuppressed, and had generally favourable treatment outcomes. All tested M. haemophilum isolates were susceptible in vitro to clarithromycin and trimethoprim-sulfamethoxazole. Moreover, high rates of susceptibility were noted for ciprofloxacin (95%), linezolid (90%), and rifampin (85%). IRIS was identified in 31% of cases and should be considered in patients who develop worsening skin lesions or systemic symptoms following the initiation of effective antimicrobial therapy. Visualisation of acid-fast bacilli on initial tissue stains, a positive mycobacterial blood culture, and rapid de-escalation of tumour necrosis factor-α inhibitors and/or corticosteroids were more frequently encountered among patients in our cohort who developed IRIS. Conclusion M. haemophilum infection should be considered among patients receiving immunomodulatory therapy who develop discoloured or nodular skin lesions involving the extremities, worsening focal arthritis, tenosynovitis, or isolated adenopathy. A heightened awareness of this pathogen’s clinical and laboratory characteristics can lead to a timely diagnosis and favourable outcome.

Analysis of real-world length of stay data and costs associated with use of autologous skin cell suspension for the treatment of small burns in U.S. centers.

Autologous skin cell suspension (ASCS) is a treatment for acute thermal burn injuries associated with significantly lower donor skin requirements than conventional split-thickness skin grafts (STSG). Projections using the BEACON model suggest that among patients with small burns (total body surface area [TBSA]<20%), use of ASCS±STSG leads to a shorter length of stay (LOS) in hospital and cost savings compared with use of STSG alone. This study evaluated whether data from real-world clinical practice corroborate these findings. Electronic medical record data were collected from January 2019 through August 2020 from 500 healthcare facilities in the United States. Adult patients receiving inpatient treatment with ASCS±STSG for small burns were identified and matched to patients receiving STSG using baseline characteristics. LOS was assumed to cost $7554/day and to account for 70% of overall costs. Mean LOS and costs were calculated for the ASCS±STSG and STSG cohorts. A total of 151 ASCS±STSG and 2243 STSG cases were identified; 63.0% of patients were male and the average age was 44.2 years. Sixty-three matches were made between cohorts. LOS was 18.5 days with ASCS±STSG and 20.6 days with STSG (difference: 2.1 days [10.2%]). This difference led to bed cost savings of $15,587.62 per ASCS±STSG patient. Overall cost savings with ASCS±STSG were $22,268.03 per patient. Analysis of real-world data shows that treatment of small burn injuries with ASCS±STSG provides reduced LOS and substantial cost savings compared with STSG, supporting the validity of the BEACON model projections.

National Amoxicillin-Clavulanate Formulation Use Pattern: A Survey.

Five commercially available amoxicillin-clavulanate (AMC) ratio formulations contribute to ratio selection variability with efficacy and toxicity implications. The objective of this survey was to determine AMC formulation use patterns across the United States. A multicenter practitioner survey was distributed to multiple listservs (American College of Clinical Pharmacy pediatrics, infectious diseases, ambulatory care, pharmacy administration; American Society of Health-System Pharmacists; Pediatric Pharmacy Association members), and selected pediatric Vizient members in June 2019. Responses were screened for multiples within institutions. Repeated organization responses were identified (n = 37) and excluded if the duplicate matched another response from the same organization exactly (n = 0). One hundred ninety independent responses were received. Nearly 62% of respondents represented a children's hospital within an acute care hospital; remainder being from stand-alone children's hospitals. Around 55% of respondents indicated prescribers were responsible for choosing the patient-specific formulation for inpatients. Nearly 70% of respondents indicated multiple formulations were available due to clinical need (efficacy, toxicity, measurable volume), whereas over 40% responded that the number of liquid formulations were limited to decrease the potential for error. Variability was demonstrated among institutions using ≥ 2 different formulations for acute otitis media (AOM), sinusitis, lower respiratory tract infection, skin and soft tissue infection, and urinary tract infection (33.6%, 37.3%, 41.5%, 35.8%, and 35.8%, respectively). The 14:1 formulation was the most common, but not exclusive, for AOM, sinusitis, and lower respiratory tract infections with 2.1%, 2.1%, and 2.6% of respondents indicating use of the 2:1 formulation and 10.9%, 15%, and 16.6% of respondents indicating use of the 4:1 formulation. Significant AMC formulation selection variability exists across the United States.

Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy.

Patient demographics, ciNPT use, postoperative complication rates, and time to adjuvant therapy were analyzed from the records of 150 patients (ciNPT = 29, SOC = 121). Propensity score matching was used to match patients based on age, body mass index, diabetes, tobacco use, and prior breast surgery. In the matched cohort, the overall complication rate of ciNPT-treated cancerous breasts was 10.3% (3/29) compared with 31% (9/29) in SOC-treated cancerous breasts (P = 0.096). Compared with the SOC-treated cancerous breasts, the ciNPT breasts had lower skin necrosis rates [1/29 (3.4%) versus 6/29 (20.7%); P = 0.091] and dehiscence rates [0/29 (0%) versus 8/29 (27.6%); P = 0.004]. In the unmatched cohort, the total number of ciNPT patients who had a delay in adjuvant therapy was lower compared to the SOC group (0% versus 22.5%, respectively; P = 0.007). Use of ciNPT following oncoplastic breast reduction effectively lowered postoperative wound healing complication rates and, most importantly, decreased delays to adjuvant therapy.