Septic Wound Research Articles

Unveiling the antimicrobial, antivirulence, and wound-healing accelerating potentials of resveratrol against carbapenem-resistant Pseudomonas aeruginosa (CRPA)-septic wound in a murine model.

Pseudomonas aeruginosa is a repertoire of several virulence factors that create a frightening high pathogenicity level as well as high antimicrobial resistance toward commercially used antibiotics. Therefore, finding a new alternative to traditional antimicrobials is a must. Resveratrol is a very famous phytochemical that harbors many beneficial health properties by possessing antibacterial, anti-inflammatory, and antioxidant properties. The current study aimed to explore the antimicrobial efficacy of resveratrol against P. aeruginosa and explore its ability to accelerate wound healing in a murine model. The obtained results revealed the potent antimicrobial, antivirulence, and wound-healing accelerating potentials of resveratrol against carbapenem-resistant P. aeruginosa (CRPA)-septic wounds. It significantly lowered the transcript levels of P. aeruginosa virulent genes toxA, pelA, and lasB. Additionally, resveratrol significantly accelerated skin wound healing by shortening the inflammatory phase and promoting re-vascularization, cell proliferation, re-epithelialization, and collagen deposition. Furthermore, it increased the immunoexpression of αSMA along with a reduction of the mRNA levels of VEGF, IL-1β, and TNF-α genes. Resveratrol has high therapeutic potential for the treatment ofP. aeruginosawound infection and is a prospective and promising candidate for this problem.

Construction of an aerolysin-based multi-epitope vaccine against Aeromonas hydrophila: an in silico machine learning and artificial intelligence-supported approach.

Aeromonas hydrophila, a gram-negative coccobacillus bacterium, can cause various infections in humans, including septic arthritis, diarrhea (traveler's diarrhea), gastroenteritis, skin and wound infections, meningitis, fulminating septicemia, enterocolitis, peritonitis, and endocarditis. It frequently occurs in aquatic environments and readily contacts humans, leading to high infection rates. This bacterium has exhibited resistance to numerous commercial antibiotics, and no vaccine has yet been developed. Aiming to combat the alarmingly high infection rate, this study utilizes in silico techniques to design a multi-epitope vaccine (MEV) candidate against this bacterium based on its aerolysin toxin, which is the most toxic and highly conserved virulence factor among the Aeromonas species. After retrieval, aerolysin was processed for B-cell and T-cell epitope mapping. Once filtered for toxicity, antigenicity, allergenicity, and solubility, the chosen epitopes were combined with an adjuvant and specific linkers to create a vaccine construct. These linkers and the adjuvant enhance the MEV's ability to elicit robust immune responses. Analyses of the predicted and improved vaccine structure revealed that 75.5%, 19.8%, and 1.3% of its amino acids occupy the most favored, additional allowed, and generously allowed regions, respectively, while its ERRAT score reached nearly 70%. Docking simulations showed the MEV exhibiting the highest interaction and binding energies (-1,023.4 kcal/mol, -923.2 kcal/mol, and -988.3 kcal/mol) with TLR-4, MHC-I, and MHC-II receptors. Further molecular dynamics simulations demonstrated the docked complexes' remarkable stability and maximum interactions, i.e., uniform RMSD, fluctuated RMSF, and lowest binding net energy. In silico models also predict the vaccine will stimulate a variety of immunological pathways following administration. These analyses suggest the vaccine's efficacy in inducing robust immune responses against A. hydrophila. With high solubility and no predicted allergic responses or toxicity, it appears safe for administration in both healthy and A. hydrophila-infected individuals.

Manipulation of Surface Electrical Charge on Nanocomposite Membranes Confers Wide Spectrum Bactericidal Effects and Promotes Tissue Regeneration

AbstractUtilization of electro‐responsive biomaterials with antibacterial properties is advantageous for facilitating septic wound healing and tissue regeneration. However, the dose‐response effects of electrical stimuli from these materials against bacteria are not rigorously characterized, and achieving synergy of bactericidal and pro‐regenerative effects of biomaterials remains a major challenge. Here, a graded series of flexible BaTiO3/P(VDF‐TrFE) electroactive nanocomposite membranes (EMs) are developed with varying surface charge intensities, to serve as antibacterial dressing for septic wound healing. EMs display broad‐spectrum antibacterial effects against both Gram‐positive and Gram‐negative bacteria in a dose‐dependent manner, depending on the magnitude of their surface electrical potential. Mechanistically, the surface charge of EMs increase intracellular levels of reactive oxygen species within bacteria cells, which in turn caused oxidative damage to the bacterial membrane, thereby suppressing bacterial activity and biofilm formation. Moreover, in vivo studies demonstrated that EMs effectively inhibited S. aureus infection and accelerated wound healing in a mouse skin defect model, as well as ameliorated P. gingivalis‐mediated periodontal inflammation in a mouse periodontitis model. Hence, this study optimizes the antibacterial properties of electroactive materials and characterizes the dose‐response effects of surface electrical charge against bacteria, thus validating the therapeutic applications of electroactive biomaterials in combating bacterial infection.

Genome Sequence Analysis of a Wohlfahrtiimonas chitiniclastica Strain Isolated from a Septic Wound of a Hospitalized Patient in Uganda

We report a genome sequence of Wohlfahrtiimonas chitiniclastica strain MUWRP0946, isolated from a hospitalized patient in Uganda. The genome size was 2.08 million bases, and the genome completeness was 94.22%. The strain carries tetracycline, folate pathway antagonist, β-lactam, and aminoglycoside antibiotic resistance genes.

Ускорение заживления экспериментально моделированных гнойных ран при локальном криовоздействии

BACKGROUND: Purulent diseases of the skin and subcutaneous tissue remain a widespread and urgent problem. The most promising methods of treatment with the active use of physical factors affecting the purulent focus are in the conditions of modern increasing resistance of microorganisms. AIM: To determine the effect of local ultra-low temperatures on the inflammatory and reparative processes in an experimental septic wound of soft tissues for planning a subsequent clinical study of the effectiveness of debridement using cryotherapy. MATERIALS AND METHODS: The experiment was conducted on 40 Wistar–Kyoto male rats of 9-month age, weighing 200 to 230 grams. The wound was created by excising an oval skin flap 2.0 × 1.5 cm in the withers region, followed by injection of 1.5 ml of Staphylococcus aureus solution at a concentration of 109 CFU/1 ml into the hypodermis. The animals were divided to 4 groups: a control group with the natural course of the healing process, and the main groups, which included a group with single daily treatment of the wound with Levomekol ointment, a group with a single daily treatment of the wound with vapor-drop jet of liquid nitrogen, and a group with single daily treatment with a combination of the above methods. The treatment was carried out during the exudative phase of the wound process. With the disappearance of exudation and of paravulnar edema and hyperemia, debridement in the main groups was stopped. In the dynamics, a comparative observation and study of planimetric changes in the wound were carried out. RESULTS: A more rapid decline of the severity of hyperemia, paravulnar edema and exudation, accelerated filling the wound with granulation tissue, accelerated epithelialization were seen in treatment with cryotherapy compared with treatment with Levomekol. These effects led to increase in the rate of wound healing due to the shortening of all phases of the wound process by at least 2 days. There were no statistically significant side effects, healing and survival occurred in all animals. CONCLUSION: In was found in the study that the use of cryotherapy leads to a rapid subsidence of symptoms, activates the processes of granulation and epithelization. Mutual potentiation of the positive effects of debridement using ultra-low temperatures and antibacterial agents has been established. Cryotherapy proved to be a safe and effective means of treating septic wounds, which does not prevent and makes it possible to conduct further clinical studies.

Genomic diversity and molecular epidemiology of a multidrug-resistant Pseudomonas aeruginosa DMC30b isolated from a hospitalized burn patient in Bangladesh

Objectives: Pseudomonas aeruginosa is a key opportunistic pathogen causing a wide range of community- and hospital-acquired infections in immunocompromised or catheterized patients. Here, we report the complete genome sequence of a multidrug-resistant (MDR) P. aeruginosa DMC30b to elucidate the genetic diversity, molecular epidemiology, and underlying mechanisms for antimicrobial resistance and virulence. Methods: P. aeruginosa DMC30b was isolated from septic wound swab of a severe burn patient. Whole-genome sequencing was performed under Ion Torrent platform. The genome was assembled using the SPAdes v. 3.12.01 in an integrated Genome Analysis Platform for Ion Torrent sequence data. The genome was annotated using the National Center for Biotechnology Information (NCBI) Prokaryotic Genome Annotation Pipeline. In-silico predictions of antimicrobial resistance genes, virulence factor genes, and metabolic functional potentials were performed using different curated bioinformatics tools. Results: P. aeruginosa DMC30b was found as a MDR strain and belonged to sequence type 244 (ST244). The complete genome size is 6 994 756 bp with a coverage of 76.76x, guanine-cytosine content of 65.7% and a Benchmarking Universal Single-Copy Orthologs score of 100. The genome of P. aeruginosa DMC30b harboured two predicted plasmid replicons (e,g. IncP-6; 78 007 bp and ColRNAI; 9359 bp), 35 resistomes (antimicrobial resistance genes) conferring resistance to 18 different antibiotics (including four beta-lactam classes), and 214 virulence factor genes. It was identified as the 167th ST244 strain among ∼ 5800 whole-genome sequences of P. aeruginosa available in the NCBI database. Conclusion: The MDR P. aeruginosa DMC30b was identified as the 167th ST244 complete genome to be submitted to the NCBI, and the first ST244 isolate sequenced from Bangladesh. The complete genome data with high genetic diversity and underlying mechanisms for antimicrobial resistance and virulence of P. aeruginosa DMC30b will aid in understanding the evolution and phylogeny of such high-risk clones and provide a solid basis for further research on MDR or extensively drug resistant strains.

Open Anterior Component Separation for Complex Incisional and Ventral Hernias—When and How? Case Series Analysis

Abstract Closing the midline in patients with incisional hernias is the cornerstone for a functional reconstruction with low morbidity, low recurrence rates, and good cosmetic results, which is the ideal outcome for every hernia surgeon. However, in patients with large hernias (usually over 10 cm width) or in loss of domain cases, this goal is difficult to achieve. Anterior component separation with or without mesh reinforcement has been the procedure of choice for these patients despite its high rate of wound complications. The goal of our study is to evaluate the opportunity and necessity of the anterior component separation in patients with complex incisional or ventral hernias (defects larger than 10 cm, infected meshes). Data of patients with large incisional/ventral hernia operated using anterior component separation technique in the past 10 years were re-visited and analyzed from hospital records between January 2012 and December 2020. Demographic data (age, gender, body mass index, ASA score) and the main steps of the technique were recorded. Data were reported as mean and standard deviation. We used the anterior component separation in 66 cases, mainly for septic conditions (open abdomen, chronic and extended infections of the abdominal wall, chronic-infected meshes). For large parietal defects with aseptic local condition, we used mesh-reinforced anterior component separation (five patients). Mean age was 68.7 years. Among them, 29 patients developed wound complications (hematoma, seroma, infection). Mean hospital stay was 12.6 days. Recurrence was 18% in patients without mesh and zero in patients with mesh reinforcement after a minimum one-year follow-up. Anterior component separation is still a valid procedure in patients with large abdominal defects especially when a septic wound is to be closed. For large parietal defects, if a wide subcutaneous dissection is required, mesh-reinforced anterior component separation remains a valid alternative in abdominal wall reconstruction in certain cases (mainly aseptic conditions).

Assessing undernutrition of trauma patients with complex soft tissue defects treated at viet duc university hospital using prealbumin serum levels

Purpose: Nutrition is playing an important role in mitigating trauma wounds, especially complex wounds. Undernutrition could cause a delay in the wound healing process and prolonged hospital stay. Thus we have conducted the study aiming to evaluate the nutritional status of trauma patients with complex soft tissue defects for the further recommendation of wound care improvement. Materials and Methodology: A prospective study of patients with complex traumatic wounds who have been treated at the Department of Septic Surgery and Wound care of Viet Duc University Hospital from 2/2020 to 2/2021. Subjects enrolled in this study include both genders, over 18 years old, with trauma wounds, are evaluated the undernutrition by pre albumin serum levels. The data was processed by software SPSS.20.0. Results: A total of 70 patients were diagnosed the complex traumatic wounds, of them, 57 males accounted for 81.4%; 13 females accounting for 18.6%; mean age was 37.1 ± 2.3. The main cause of injuries was road traffic accidents, accounting for 78 %, and occupational accidents accounting for 22%. 21.4% of patients were reported to have soft tissue wounds only, the remaining 78.6% were with complex lesions including tendon and bone damaged. Co-morbidities accounted for 20% (Mellitus diabetes), 15.7% (heart diseases). No one in serious status of undernutrition (pre albumin serum <5.0 mg/dL), however, 5.0 to 10.9 mg/dL accounted for 28.6%, and 15.0 to 35.0 mg/dL accounted for 71.4% respectively. Healing time <1 week was 8.6%, from 1-3 weeks in 72.9%, and more than 3 weeks in 18.5%. Complications with serious necrosis requiring more debridements accounted for 8.6%. Conclusions and Recommendations: Results from the study show that nutritional evaluation is useful in complex traumatic wounds treatment. Careful and daily check of wounds, evaluation of healing progress as well as the patient nutritional status can make the appropriate treatments which might help to improve the healing progress.

"Remarks on Severity of Trauma Patients Due to Road Traffic Accidents have Been Treated at Vietduc University Hospital Assessed by RTS"

Nguyen Duc Chinh1*, Dinh Van Quynh1,2 and Vuong Quoc Duc1 Author Affiliations 1Department of Septic surgery and Wound care, Viet Duc University Hospital, Veitnam 2Thang Long University, Veitnam Received: October 10, 2021 | Published: October 22, 2021 Corresponding author: Nguyen Duc Chinh, Department of Septic surgery and Wound care, Viet Duc University Hospital, Veitnam DOI: 10.26717/BJSTR.2021.39.006319

A Nonhealing or Intransigent Phase of a Septic Wound Ulcer on the Left Lower Limb for Over 30 Years without Clinical Diabetes: A Case Report

Chronic nonhealing wounds are painful with both psychological and financial cost to the affected patient tied to extensive economic repercussion on society. Here, we present a case of a 54-year-old man who has been living with a painful nonhealing septic ulcer wound for more than 30 years. Clinical examination revealed an extensive septic ulcerative wound on the lower left extremity with multiple ulcerative lesions covering the peroneus brevis, digitorum longus and the foot with erythema and oedema. Doppler scan revealed femoral arteries with thick veins that had undergone 25% stenosis. The left popliteal vein had 25% stenosis with distal obstruction to blood flow with elevated peaks of systolic velocity whiles the posterior tibial artery showed a reduced flow with abnormal waveform and an intraluminal plaque formation of about 50% stenosis. This chronic nonhealing wound requires a more sophisticated wound healing intervention such as arterial revascularisation, debridement, treatment with antimicrobials and organogenesis dressing to permit wound healing. Keywords: Acute and chronic wounds, Septic ulcer, lower limbs, arterial revascularization, debridement, organogenesis dressing, amputation. Read more →

Synthesis of silver-nisin nanoparticles with low cytotoxicity as antimicrobials against biofilm-forming pathogens

Wound infection is a serious threat to patients, in particular those with septic wound infections, which result in high mortality rates. Moreover, the treatment of wound infections with antimicrobial-resistant and/or biofilm-forming pathogens can be challenging. Nisin, a potent antimicrobial against Gram-positive bacterial pathogens, has been used in the food industry as a preservative for decades. Silver has been approved by the FDA as a topical antimicrobial. Here, we show that silver-nisin nanoparticles (Ag-nisin NP), with an average diameter of 60 nm, can be quickly synthesized with the assistance of a simple microwave. Ag-nisin NP act as bactericidal antibiotics against the tested pathogens. In contrast, resistance was observed in S. aureus and A. baumannii that were treated with silver nitrate alone. In addition, Ag-nisin NP showed potent antibiofilm activity against S. aureus, P. aeruginosa, A. baumannii, K. pneumoniae, and E. coli, which are pathogens occurring in wound infections. Notably, the synthesized Ag-nisin NP showed lower cytotoxicity than silver nitrate to human cells. This formulation provides an alternative and safe measurement for biofilm-infected wound control.

Association of serum albumin with postoperative complication in major surgeries

Background: Nutritional assessment is essential for identifying patients who are at risk of developing complications related to significant malnutrition. Serum albumin is the most important laboratory test for the diagnosis of protein-calorie under nutrition.Methods: A COHORT of 100 patients admitted for major elective surgery in the department of general surgery, Government medical college and hospital, Ambikapur, Sarguja, Chattisgarh, India. Patients who were admitted and undergoing any major elective surgeries having age above 12 years were included. Details of cases were recorded including demographic characteristics, history and clinical examination along with BMI and serum albumin.Results: Complication rate was highest in the age group of 51-60 years (57.9%) followed by the age group of 41-50 years (53.8%). The association was found statistically significant between different level of serum albumin level and their post-operative wound complications. The highest complication rate was seen in patients with renal procedures like nephrectomy and pyelolithotomy (60.0%) but the most common type of procedure observed was bowel resection and anastomosis (38.7%).Conclusions: The correlation between the serum albumin and complication rate was statistically significant in the malignant diseases when considered separately. Low serum albumin level can be used as a marker for nutritional deficiency and TPN as nutritional supplementation in certain subset of patients may reduce postoperatively septic wound complication.

Bacteriophages: A Potential New Therapeutic Alternate to Antibiotics to Treat Chronic Septic Wounds in Large Animals

Background: Overuse of antibiotics is a major problem in the treatment of chronic infections. The antibiotic treatment is frequently non-curative due to emergence of antibiotic resistance, thus alternative treatment is necessary. The natural ability of pathogens to develop resistance is not only a threat to animal health but also leads to accumulation of antibiotic resistance determinants or resistant bacteria livestock products. Phage therapy has been developed as an alternative therapeutic approach against antibiotic resistance microorganisms.Methods: In present study 150 samples of sewage were collected from livestock farm, NDVSU, Jabalpur (M.P.). Bacteriophages were isolated and characterized from the collected sewage samples. “Cocktail” of the recovered phage lysate isolates (ØVS1, ØVS5, ØVS9 and ØVS27) was prepared for assessment of therapeutic utility of S. aureus phages in chronic septic infections. Therapeutic trial was performed in large animals (cattle and buffalo) at livestock farm, Adhartal, NDVSU, Jabalpur (MP.). Pathogens isolated from chronic septic wounds were showing antibiotic resistance but the bacteria were sensitive to phage lysate. Phage ‘cocktail’ was applied topically over the chronic septic wounds as single dose. Follow up of the cases was done at regular intervals (0, 5 and 10 days) which included clinical examination of wound by appearance, status of discharge and formation of granulation tissue.Result: Six animals showed complete recovery (60%) out of 10 animals from wounds as predicted by progressive healing status of wounds till the formation of granulation tissue within 10 days after phage application. Thus, recovery was much higher than the conventional antibiotic therapy normally used for the treatment of chronic septic wound infections in animals.

Postpartum endometritis after uterine cleaning versus no cleaning in cesarean sections: Randomized clinical trial.

The aim of the study was to compare the rates of postpartum endometritis due to uterine cleaning and no cleaning in patients delivered by elective cesarean section. This was a randomized clinical trial conducted at the Obstetrics and Gynecology Department, Suez Canal University Hospital, Ismailia, from June 2019 to November 2019. We recruited patients undergoing cesarean delivery aged 18-45 years with singleton pregnancy, intact membranes, either first or repeated delivery, without labor pains. Patients were allocated into two groups, uterine cleaning (336 patients) and no cleaning (312 patients). The main outcome measure was the occurrence of postpartum endometritis. Both groups were matched in their demographic characters. Twelve patients (3.6%) developed endometritis in the cleaning group versus one patient (0.3%) in the other one. Estimated blood loss was 754.35 ± 247.13 and 730.36 ± 232.77 for the cleaning and no cleaning groups, respectively, with a P value of 0.201. Septic wound infection (21 patients, 6.3%) was predominant in the cleaning group. Uterine cleaning after delivery of the placenta during CS can be omitted as a surgical step during the operation. It was associated with increased rates of postpartum endometritis and blood loss.

ФАКТОРЫ РАЗВИТИЯ РЕЦИДИВНЫХ ВЕНТРАЛЬНЫХ ГРЫЖ

A literature review on the types of hernias of the anterior abdominal wall (HAAW) is presented. The analysis shows that HAAW are the most common pathology among abdominal surgical diseases. The factors contributing to development of ventral recurrent and postoperative HAAW are summarized. Statistical data indicating their incidence are presented, the causes of the pathology recurrence are considered. Different aspects of development of the abdominal compartment syndrome and septic purulent wound complications are discussed, and the influence of various complications on the outcome of surgical interventions are considered. Keywords: Recurrent ventral hernia, postoperative ventral hernia, intraabdominal hypertension, abdominal compartment syndrome, tension-free hernioplasty.

Green Synthesis of Silver Nanoparticles and Evaluation of Their Antibacterial Activity against Multidrug-Resistant Bacteria and Wound Healing Efficacy Using a Murine Model.

Green nanotechnology has significant applications in various biomedical science fields. In this study, green-synthesized silver nanoparticles, prepared by using Catharanthus roseus and Azadirachta indica extracts, were characterized using UV–Vis spectroscopy, dynamic light scattering, X-ray diffraction, scanning electron microscopy, and transmission electron microscopy. Silver nanoparticles (Ag NPs) synthesized from leaf extracts of C. roseus and A. indica effectively inhibited the growth of multidrug-resistant (MDR) bacteria isolated from patients with septic wound infections. The maximum bacteriolytic activity of the green-synthesized Ag NPs of C. roseus and A. indica against the MDR bacterium K. Pneumoniae was shown by a zone of inhibition of 19 and 16 mm, respectively. C. roseus Ag NPs exhibited more bacteriolytic activity than A. indica Ag NPs in terms of the zone of inhibition. Moreover, these particles were effective in healing wounds in BALB/c mice. Ag NPs of C. roseus and A. indica enhanced wound healing by 94% ± 1% and 87% ± 1%, respectively. Our data suggest that Ag NPs from C. roseus and A. indicia ameliorate excision wounds, and wound healing could be due to their effective antimicrobial activity against MDR bacteria. Hence, these Ag NPs could be potential therapeutic agents for the treatment of wounds.

Therapeutic index for local infections score (TILI): a new diagnostic tool

Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decision-making on antiseptic therapy or decolonisation. An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe.

Opportunistic parasites associated mortality in a nutritionally compromised young wild Bengal tiger

Present communication deals with unusual observations made during the post mortem examination of a subadult wild tiger from the Pilibhit Tiger Reserve of Uttar Pradesh (India). Physical examination revealed hide bound condition, dull appearance of body coat, old healed fracture of right radius and septic wound in right forelimb apart from a spine of porcupine piercing the nasal septum causing nose bleeding. Organ-wise inspection revealed presence of Dirofilaria immitis adult worms (n=3) in the right ventricle of the heart, Physaloptera sp. in the stomach, Toxocara cati, Ancylostoma sp., Taenia sp. and Spirometra sp. in the small intestine. Examination of intestinal content revealed eggs of Paragonimus sp. and Trichuris sp. along with large number of Isospora sp. oocysts apart from eggs of Toxocara, Ancylostoma, Taenia and Spirometra. The intensity of worms recovered (parasitic load) from the tiger in the present case was found to be surprising in the sense that despite of specific micro-environment requirement of each parasitic species, host allowed buildup of severe infection of almost all the parasitic genera. This situation might have arisen due to compromised immune status of the tiger due to prolonged starvation because of difficulty in catching the prey. All these parasites are present in the tiger reserve and pose a threat to this priceless animal species, especially if the host is immunocompromised.

Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures.

Soft tissues (wound dehiscence, skin necrosis) and septic (wound infection, osteomyelitis) complications have been historically recognized as the most frequent complications in surgical treatment of high-energy proximal tibia fractures (PTFs). Staged management with a temporary external fixator is a commonly accepted strategy to prevent these complications. Nonetheless, there is a lack of evidence about when and how definitive external or internal definitive fixation should be chosen, and which variables are more relevant in determining soft tissues and septic complications risk. The aim of the present study is to retrospectively evaluate at midterm follow-up the results of a staged management protocol applied in a single trauma center for selective PTFs. The study population included 24 cases of high-energy PTFs treated with spanning external fixation followed by delayed internal fixation. Severity of soft tissues damage and fracture type, timing of definitive treatment, clinical (ROM, knee stability, WOMAC and IOWA scores) and radiographic results as well as complications were recorded. Complex fracture patterns were prevalent (AO C3 58.3%, Schatzker V-VI 79.1%), with severe soft tissues damage in 50% of cases. Mean time to definitive internal fixation was 6days, with double-plate fixation mostly chosen. Clinical results were highly satisfying, with mean WOMAC and IOWA scores as 21.3 and 82.5, respectively. Soft tissue complication incidence was very low, with a single case of wound superficial infection (4.3%) and no cases (0%) of deep infection, skin necrosis or osteomyelitis. Staged management of high-energy PTFs leads to satisfying clinical and radiographic results with few complications in selected patients.

Dynamics of postsurgical wound local changes and healing rate during the use of alpha-glutamyl-tryptophan in combination therapy of patients with skin and soft-tissue infections

Skin and soft-tissue infections (SSTI) take the lead in surgical disorders. Changes of local and systemic immunoreactivity highlight the SSTI and hinder treatment due to disease chronicity. The immunotropic therapy could be the useful tool in SSTI treatment. The aim of the study was to assess the dynamics of local changes and and duration of wound healing during the use of alpha-glutamyl-tryptophan (AGT/Thymogen) in the combination therapy of SSTI patients. Material and methods. A sample of 77 individuals aged 18–55 years with moderate SSTI of different localization and with signs of infectious intoxication participated in the randomized, double-blind, parallel group, placebo-controlled clinical trial. The patients were divided into the main (39 people) and control (38 people) groups. The combination therapy of the main group included 100 μg of AGT by intramuscular injection daily during 7 days, whereas the control group received placebo (0,9 % sodium chloride) along the same schedule. Results and discussion. The combination therapy of SSTI patients with AGT significantly decreased the local inflammation, i.e. pain intensity, hyperemia, edema (p = 0,022), infiltration within damage area (p = 0,03). Besides, AGT treatment leads to statistically and clinically significant reduction in the duration of septic wound healing by an average of 2 days as compared to control group. Thus, statistically, and clinically significant superiority of efficacy of alpha-glutamyl-tryptophan in comparison with placebo in reducing the time of healing of purulent wounds of patients with SSTI has been established.