Silver Sulfadiazine Cream Research Articles

Evaluation and HPLC characterisation of a new herbal ointment for the treatment of full-thickness burns in rats

ObjectiveBurn injuries are among the most common accidental health problems worldwide, frequently leading to health and socio-economic challenges. Despite this, no standard protocol for managing burn injuries can overcome the adverse effects of currently used drugs. The present study sets out to develop and evaluate the efficacy of new herbal ointments in providing synergistic anti-inflammatory, antimicrobial, antioxidant, and cell-proliferating activities. It also investigates the high-performance liquid chromatography (HPLC) characterisation of these new herbal ointments. MethodThree different concentrations of the new herbal ointment, which incorporates extracts of Matricaria aurea flower heads, arial parts of Calendula tripterocarpa, Rosmarinus officinalis leaves, Alkanna tinctoria roots, and myrrh were developed and evaluated. Ointments designed to promote burn-wound healing were prepared and compared with β-sitosterol ointment and silver sulfadiazine cream, as a commercial standards. ResultsAccording to statistical and histopathological analyses and visual inspections, the new herbal formulas showed faster wound healing, more tolerability, and less toxicity than the commercial standards. ConclusionThe new herbal ointments, developed in our study, have shown promising results. The formula offers mechanical protection without any release of non-biodegradable particles. It maintains the optimum moisture and pH of the skin, while minimising scar-tissue formation. These advantages, in addition to availability, low costs, and easy handling, may support the use of this new herbal formula as an effective and safe alternative treatment, designed to promote the healing of burn injuries.

Effects of Topical Application of Royal Jelly on Second-Degree Burn Wound Healing in Male Rats

Background and Aims: Burn injury remain as a major medical problem throughout the world. This injury is accompanied with inflammatory and wound healing responses. Since royal jelly (RJ) has anti-inflammatory and wound healing activity therefore, the aim of this study was to evaluate the repairing effects of RJ on skin burn- damage. Materials and Methods: In an experimental study, 40 male Wistar rats (8 weeks old) were engaged. The animals were divided into five equal groups. Group 1 was considered healthy control. Group 2 (positive control) was treated topically with Silver Sulfadiazine Cream, group 3 received Eucerin as negative control, and group 4, 5 treated with RJ (10 and 30%). Sampling was performed after observing the second-degree burns on the first, seventh and fourteenth days. Then after 28 days, rats were sacrificed and their skin tissues were used for morphological and morphometric assessments. Results: The results of this study showed that the amount and arrangement of collagen type 1 protein was higher in the RJ treatment groups versus control group. Reconstruction and thickening of the epithelium in RJ treated groups confirmed therapeutic effects of RJ. In addition, RJ increased angiogenesis compared to the control group. The woundchr('39')s surface area was reduced in the RJ treatment groups compared to the control group. In addition, fibroblast cell proliferation was increased in the groups receiving RJ versus control. Conclusions: It could be concluded that, RJ induce wound healing effects and might be considered as potential treatment option to improve the burn wound healing.

Treating hard-to-heal ulcers: biocellulose with nanosilver compared with silver sulfadiazine.

Controlling infection and promoting healing should be the aims of hard-to-heal diabetic ulcer treatment, along with improving a patient's general condition and their blood sugar control. Many hard-to-heal diabetic ulcers present with cavities, tracks or a combination of these. There is a new biocellulose (with a nanosilver dressing) which has the ability to contour around and conform to the irregular surface of a wound bed. The purpose of this study was to evaluate its efficacy compared with a silver sulfadiazine cream, for hard-to-heal diabetic ulcer treatment. In this randomised control trial, patients with hard-to-heal diabetic ulcers were divided into two equal-sized groups: treatment with the biocellulose with blue nanosilver (experimental group), and treatment with silver sulfadiazine cream group (control group). Cotton gauze was used as the secondary dressing for both groups. Demographic data, wound size, wound classification, wound photography and bacterial cultures were recorded at the beginning of the study. Wounds were debrided as necessary. Dressings were changed twice daily in the control group, and every three days in the experimental group. A total of 20 patients took part in the study (10 patients in each group). The highest mean wound healing rates were 91.4% in the experimental group and 83.9% in the control group. No wound infections or adverse effects from the dressings were detected in either group. In this study, biocellulose with blue nanosilver adapted well to the wound bed. Wound reduction was greater in the experimental group than the control group. Biocellulose with blue nanosilver could therefore be a good choice for hard-to-heal diabetic ulcer treatment, due to its good healing rates and minimal care requirements.

A comparative study of the efficacy of nanocrystalline silver gel and silver sulfadiazine cream on the healing of second degree burn wound

Background: The final aim of burn management is to prevent infection, to promote early epithelialization as well as healing of wound and betterment of functional and asthetic after effects. The present study aimed to compare the effect of nano crystalline silver gel and silver sulfadiazine cream on the healing of second-degree burn wounds.Methods: After matching the inclusion and exclusion criteriaburn wounds of patients were divided into two parts (sides); one part was dressed with silver sulfadiazine cream and the other one was dressed with nano crystalline silver gel. The wound dressing was changed everyday after washing the wound with normal saline. Wound parameters were measured on the ninth day and twenth day of dressing, using clinical assessment and photographic tool. The obtained data were statistically analyzed using the Chi-square test.Results: In our study, most patients were noted to have increased epithelization, increased granulation tissue, decreased inflammation, decreased wound infection as well as decreased slough following dressing with both nanocrystalline silver gel and silver sulfadiazine cream but there were more in numbers of patients dressing with nanocrystalline silver gel.Conclusions: The effect of nanocrystalline silver gel on the reduction of the healing time and necrotic tissue amount and increasing the granulation, epithelialization, and necrotic tissue type was greater. Considering the above findings nanocrystalline silver gel is more recommended to be used for burn wounds.

Non-contact Low-frequency Ultrasound (NCLF) to Improve Dermatitis and Quality of Life after Radiation Therapy: The Soothe Study

Radiation dermatitis is the most common acute sequela of radiation therapy in the treatment of breast cancer. Radiation dermatitis not only affects quality of life but can also interfere with the treatment course. Acute dermatitis typically continues to progress up to 14 days after completion of radiation therapy. Dependent on the severity, management may include the use of topical emollients, steroids, and/or silver sulfadiazine, along with oral analgesics. Non-contact low-frequency ultrasound (NCLF) is well established in the management of chronic cutaneous wounds but has never been studied specifically on radiation induced dermatitis. The mechanism of action of NCLF is not well understood, but believed to decrease bacterial count and inflammatory cytokines while stimulating cellular activity. Our aim was to investigate whether the addition of NCLF to standard of care results in accelerated resolution of acute radiation dermatitis and improvement in patient’s quality of life compared to standard of care alone. Eligible patients were those who completed post-lumpectomy or post-mastectomy radiation therapy and acquired grade 2 dermatitis or above (per NCI CTCAE scale). Once enrolled, patients were randomized to receive standard of care (SOC) treatment with daily applications of silver sulfadiazine cream (control group) or SOC plus NCLF (treatment group) utilizing NCLF once per day for approximately 10 minutes to the affected area until grade 1 dermatitis was achieved. All patients agreed to a photograph daily of the affected area. The number of days it took for the treated area to reduce to grade 1 dermatitis was recorded. The patient was then discharged from the study and instructed to continue SOC treatment as needed. All patients completed the Health State Visual Analogue Scale (VAS) at enrollment and again at the end of the study period. Sixty-three female breast cancer patients with grade 2 radiation dermatitis were prospectively enrolled. 33 patients were randomized to SOC and 30 patients randomized to SOC plus NCLF. Patients in the SOC plus NCLF group took less time to resolve to a grade 1 dermatitis (Mean = 7.77 days, SE = 0.569), than those who received SOC alone (Mean = 10.52 days, SE = 0.698). This difference was clinically and statistically significant at 2.75 days (t = 3.053, p = 0.0017). The SOC plus NCLF group had a larger increase in their VAS score than those who received SOC alone (17 vs 12 respectively), however this was not statistically significant (t = -0.96, p = 0.34). When added to the standard of care, non-contact low frequency ultrasound accelerates the transition of grade 2 to grade 1 radiation dermatitis in breast cancer patients undergoing post-operative radiation therapy. The reduction in days of healing may translate to an improvement in quality of life in the immediate post-radiation period. Further investigation is necessary to determine cost effectiveness of NCLF and wider range of its applications in radiation therapy.

Comparing the Effects of a Herbal Ointment (Based on Persian Medicine) and Silver Sulfadiazine Ointment on the Second-Degree Burn Wounds: a Single-Blind Randomized Clinical Trial

Background and Objective: Burn injuries impose heavy costs on the healthcare systems. Since the available treatments for burn injuries are costly and have several complications, the present study aimed to compare the effects of an Iranian traditional medicine product in the form of a herbal ointment with silver sulfadiazine ointment on second-degree burn wounds. Methods: In this single-blind randomized clinical trial, the patients were divided into two groups of herbal ointment (Rosa damascena, Solanum nigrum, and Malva sylvestris) and SSD ointment (control). They were evaluated in terms of improvement, wound closure, wound appearance, and intervention complications prior to the treatment, on the fourth day, and after 1-4 weeks. Results: Fifty three participants completed the trial (27 in herbal ointment and 26 in SSD group). The mean burn wound healing time was 11.58±5.36 and 16.80±5.60 days in the herbal and SSD groups, respectively, which showed a significant difference in this regard (p=0.001). Moreover, the wound closure percentage in the first two weeks was significantly higher in the herbal group compared to the SSD group (p <0.05). Also, wound appearance was better in the herbal ointment group in all the assessment times. No significant difference was observed between the herbal and SSD ointment regarding the treatment complications. Conclusion: The herbal ointment containing Rosa damascena, Malva sylvestris, and Solanum nigrum showed more considerable effects on the second-degree burn wounds compared to the SSD ointment.

Wound dressing of second degree burn by chamomile cream and Silver sulfadiazine cream; the effects on wound healing duration; a triple blind RCT

Wound dressing of second degree burn by chamomile cream and Silver sulfadiazine cream; the effects on wound healing duration; a triple blind RCT

Application of Compound Polymyxin B Ointment in the Treatment of Chronic Refractory Wounds

The purpose of this study was to investigate the clinical efficacy of compound polymyxin B ointment for treating chronic refractory wounds. A retrospective analysis was performed on 111 patients who underwent chronic refractory wound treatment. Patients were divided into 2 groups, with 45 patients included in the experimental group (compound polymyxin B group) and 66 patients included in the control group (silver sulfadiazine group). After thorough debridement in both groups, either compound polymyxin B ointment or silver sulfadiazine cream was evenly applied to the patient's wound and covered with sterile gauze. In both groups, dressing changes were dependent on the wound's condition and secretions. Using the Bates-Jensen Wound Assessment Tool (BWAT), patients in both groups were scored, after which wound healing, infection, and healing time were compared. There was no significant difference in BWAT scores between the 2 groups on the 7th or 14th day; however, on the 21st day, the BWAT score in the experimental group was significantly lower than that of the control group. The difference was statistically significant (P < .05). There was no significant difference in the BWAT-I scores between the 2 groups on the seventh day. The healing time in the experimental group was significantly shorter than that of the control group, and the difference was statistically significant (P < .05). For the treatment of chronic refractory wounds, thorough debridement followed by compound polymyxin B ointment topical application can reduce and control wound infection effectively and accelerate the process of wound repair.

A Dermal Gel Made of Rutilus Kutum Skin Collagen-Chitosan for Deep Burn Healing

Natural compounds extracted from marine organisms consisting of biological active materials like collagen provide a major source of compound with medical applications including wound dressing particularly in co-treatment with other natural or synthetic materials to quick the wound healing process. The current study investigates the potential of Rutilus kutum skin-extracted collagen in combination with chitosan [collagen-chitosan (Col-CH) gel] for in vivo second-degree burn wound healing in rats following finding of the most effective collagen-chitosan ratio. Collagen and chitosan were extracted from R. Kutum skin and shell waste of shrimp, respectively, using acid–base method. SDS-PAGE was performed to determine subunit composition of collagen. After amino acid analysis using HPLC, different ratios of collagen and chitosan mixture (Col-CH, 1:3, 1:1 and 3:1) were prepared to fine the most effective of Col-CH gel on burn wound healing and compare to animals treated with silver sulfadiazine ointment. Wound surface area was analyzed using ImageJ software on days 15 and 30. H&E staining was performed to show the epithelialization, collagen deposition, fibroblast cell accumulation and vessel formation on days 15 and 30. The results from H&E were scored and quantified by pathologist. SDS-PAGE technique revealed that extracted-collagen was type 1 composed of two α (α1 and α2) chains. HPLC showed that Glycine was the most abundant amino acid which included one-third of total amino acid in the skin. The wound surface measurement showed a significant reduction in wound size in animals treated with Col-CH (1:1) compared to silver sulfadiazine treated group at day 25. Histopathological findings represented high score in epithelialization, vessel formation and a decrease in inflammatory cells infiltration in Col-CH (1:1) treated group on days 15 and 30. These data suggest collagen in combination with chitosan with 1:1 ratio can significantly restore burn wound compared to silver sulfadiazine ointment.

Veno-arterial extracorporeal membrane oxygenation for electrical injury induced cardiogenic shock support: a case report

BackgroundHigh voltage electrical injury (HVEI) of more than 1000 V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality.We present the first case of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a life saving device for treating a patient with severe cardiogenic shock after a high voltage electrical injury.Case presentationA 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 V. He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and was transported to the nearest medical centre with severe cardiogenic shock with an ejection fraction (EF) of < 10%.Upon arrival, he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by intravenous (IV) inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point located on his right leg. Blood pH was 6.8, PCO2 53 mmHg, PaO2 of 57 mmHg, lactate 8 mmol/L, and Troponin 38,000 ng/dl. The EF was 10% with global severe left ventricular dysfunction. During cardiopulmonary resuscitation (CPR), including cardiac massage and few electrical shocks, he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion.He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns. He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the VA-ECMO, and underwent decannulation 86 h after initialization. He was discharged on day 27 without any sequelae.ConclusionThe VA-ECMO treatment can be a lifesaving device for treating severe cardiogenic shock caused by high voltage electrical injury, and should be considered while treating these “high-mortality risk” patients.

Zerumbone-Loaded Nanostructured Lipid Carrier Gel Facilitates Wound Healing in Rats

Zerumbone, a natural lipophilic compound from Zingiber zerumbet (L.) Roscoe ex Sm., Zingiberaceae, has anti-inflammatory effects. The study investigated the healing effects of zerumbone-loaded nanostructured lipid carrier gel on excisional wounds in rats. Zerumbone-loaded nanostructured lipid carrier gel was prepared using the Carbopol 940 as the gelling agent. The wounds were topically treated with 0.2 ml of zerumbone-loaded nanostructured lipid carrier gel (0.5 mg/ml) once daily for 15 days. Silver sulfadiazine 1% w/w cream (0.2 ml) and nanostructured lipid carrier gel (0.2 ml) were used for comparison. Tissue samples were subjected to histopathology, the determination of cytokine concentrations, and cyclooxygenase-2 gene expression. Zerumbone-loaded nanostructured lipid carrier gel decreased inflammatory cell infiltration and degeneration, and increased granulation in the healing wound tissues. Anti-inflammatory effect was also observed by the increase of anti-inflammatory interleukin-10, and decreased the pro-inflammatory tissue necrosis factor-α, interleukin-6 concentrations, and downregulated cyclooxygenase-2 gene expression. Zerumbone-loaded nanostructured lipid carrier gel was more effective than silver sulfadiazine cream at inducing wounds healing. In conclusion, zerumbone-loaded nanostructured lipid carrier gel promotes wound healing and scarless tissue repairment by increasing production of anti-inflammatory cytokines and downregulating pro-inflammatory gene expression.

657 Preliminary Study on the Effect of Various Antimicrobial Formulations Containing Silver Oxynitrate on Reducing Pseudomonas Aeruginosa Using an in-vivo Porcine Burn Wound Model

Abstract Introduction Silver has long been known for its antimicrobial effects and has been commonly applied topically to burn wounds for years. More recently, wound dressings compounded with silver ions, have been developed to prevent and treat wound infection in both burn and chronic wounds. Methods This preliminary study evaluates the effect of a proprietary silver oxynitrate creams on Pseudomonas aeruginosa (PA) biofilms using a well-established burn wound porcine model model. Swine were used due to their skins similarities to humans and response to wound treatments. Briefly, second degree burn wounds were created and inoculated with PA. Wounds were then covered for 24 hours with a polyurethane dressing to allow for biofilm formation. The polyurethane dressing was removed and wounds were randomly assigned to one of the following treatment groups: 1) silver oxynitrate cream 0%, 2) silver oxynitrate cream 4%, 3) silver oxynitrate cream 7%, 4) silver oxynitrate cream * 10%, 5) silver oxynitrate powder, 6) silver sulfadiazine cream (SSD)~, or 7) untreated control. All treatments groups were covered with a polyurethane dressing to prevent any cross contamination. On days 3 and 7 after wounding wounds were cultured using an established scrub technique. Results Silver oxynitrate powder was the most effective treatment group at reducing PA counts. Silver oxynitrate 10% formulation had a high percentage of bacterial reduction. On day 7, compared to untreated control the silver oxynitrate 4, 7 and 10% treatments showed a 3.45, 4.05, and 4.30 log CFU/ml reduction, respectively. Conclusions These studies suggest that the silver oxynitrate formulations can reduce the bacterial bioburden in vivo against wounds that have PA biofilms. Additional animals are needed to substantiate these findings. Applicability of Research to Practice Gram-negative bacteria such as PA pose a challenge for wound care practitioners and new effective therapies are needed.

732 Evaluating the Cost-effectiveness, Efficacy, Safety, and Tolerance of Silver Sulfadiazine Dressings Once Daily versus Twice Daily in the Treatment of Burn Wounds

Abstract Introduction Topical antibacterial agents are an essential component of burn wound management. The aim is to prevent wound infection effectively and promote healing. A poorly treated wound can result in scarring or even sepsis and multi-organ dysfunction in severe cases. Topical Silver Sulfadiazine cream (SSD 1%) has been the gold standard for burn care since 1960s. Due to the immediate burst release of the drug into the exposed areas, application is relatively frequent, usually twice daily. However, it remains unknown whether twice-daily SSD dressings are superior to once-daily. Methods Our institution maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after the change. Our main outcomes recorded are wound infection, average pain scores, average daily narcotic requirements and length-of-stay. Results Preliminary results of 20 pre-change-of-practice and 20 post-change-of-practice patients showed no difference in the outcomes between the two groups. The infection rates were the same for both groups (15%), average pain scores (Graph 1) for the post-change group were slightly higher (pre=5.5, post=5.8; p=0.7), average length-of-stay (Graph 2) was longer in the pre-change group (pre=9.2, post=5.7; p=0.04), and no other surgical complications were reported for patients in either group. Conclusions Preliminary results show that a once-daily dressing change of SSD, has no negative impact on burn wound outcomes. In addition, it is associated with a decreased length-of-stay. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. Changing the standard-of-care to once-daily could prove beneficial. Further patient review will shed more light on the significance of these results, however so far there is no inferiority in wound healing. Applicability of Research to Practice The frequency of dressing changes directly affects staff workload who are required to spend a lot of time carefully changing dressings. In addition, patient discomfort associated with frequent dressing changes including interference with sleep hygiene and increased pain medications could also be avoided. Finally, fewer dressing changes are associated with less medical supplies and hospital utilization without putting the patient at any further risk of infection.

Preparation and evaluation of burns wound healing ointment base of leaves and stem bark of Anthocleista djalonensis (L) extract using animal model.

BACKGROUND: Burn wounds are inescapable life events especially in low income areas. Contamination of the burn wound site results in localized wound infection, hence the need for potent phytochemicals readily available for wound healing. The use of stem bark of Anthocleista djalonensis efficacy for burn wound has not been evaluated to the best of our knowledge.&#x0D; AIM: The study is aimed at evaluating and comparing the wound healing potential of ointment base of leaves and Stem bark of Anthocleista djalonensis on burn wounds created on wistar albino rats.&#x0D; METHODS: The leaves and Stem bark of Anthocleista djalonensis collected were extracted using 95%v/v methanol and phytochemical analysis conducted. Simple ointments of varying concentrations were formulated to screen for wound healing activity using the burn wound model on experimental rats grouped into six (n=4). Group 1 was treated with silver sulfadiazine cream (positive control), group 2 with ointment base (negative control), group 3 with 1% stem bark extract ointment, group 4 with 2% stem bark ointment, group 5 with 1% leave extract ointment, and group 6 with 2% leave extract ointment. All animals were anesthetized before the creation of burn wounds. Measurement was taken on day zero and the wound was left untreated for 48 hours in order to allow bacterial colonization before daily treatment of the wound for 16 days.&#x0D; RESULTS: The result of the phytochemical screening revealed that both extract of Anthocleista djalonensis contains flavonoids, tannins and saponins. On day 2, 1% stem bark, 2% stem bark and 1% leaf extract had 16%, 15%, and 10% wound contraction respectively which was higher than the 8.5% wound contraction of silver sulfadiazine. Also as the concentration of the extract increased, the wound healing effect also increased as seen by the percentage wound contraction on day 16 for all treatment.&#x0D; CONCLUSION: The findings of the study have shown that methanolic extracts of stem bark and leaf of Anthocleista djalonensis contained bioactive constituents which have burn wound healing activity. The stem bark extract showed better activity when compared with the leaf extract and also the positive control (silver sulfadiazine).&#x0D; &#x0D;

Complex clinical and therapeutic rehabilitation approach of a patient with complete AIS/Frankel A tetraplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study

Introduction: Spinal cord injury is a complex neurologic condition that embeds multiple complications, which are often debilitating for patients as the disease progresses. Materials and Methods: This paper presents a case of a 44-year-old patient with a longilin asthenic constitution and no previous medical history, who accidentally fell off a trailer resulting in burst fracture dislocation of C6/C7 associated with immediate loss and consciousness and onset of complete ASIA-A tetraplegia with C5 neurologic level. The patient received a complex nursing program, which included extensive debridement of the necrotic tissue, daily antiseptic wound dressing using Chloramine solution and silver sulfadiazine cream along with wide-spectrum antibiotic therapy with slow but favorable progression. During hospitalization the patient developed an episode of respiratory distress which responded favorably to Levocetirizine daily. Results: The complex neuro-muscular rehabilitation program along with the medical treatment and surgical debridement the patient received have improved of the clinical outcome with the shrinkage of the pressure point lesions, adequate respiratory function which permitted the mobilization of the patient with the wheelchair. Conclusions: Patients with spinal cord injuries are prone to a vast majority of complications including pressure sores complicated with necrotizing fasciitis and respiratory distress that could alter the quality of life. Proper monitoring and management of these kind of complications in the context of neuromuscular rehabilitation are necessary for the enhancement of the quality of life. Key words: spinal cord injury, tetraplegia, complications,

SPS-neutralization in tissue samples for efficacy testing of antimicrobial peptides

BackgroundAccurate determination of the efficacy of antimicrobial agents requires neutralization of residual antimicrobial activity in the samples before microbiological assessment of the number of surviving bacteria. Sodium polyanethol sulfonate (SPS) is a known neutralizer for the antimicrobial activity of aminoglycosides and polymyxins. In this study, we evaluated the ability of SPS to neutralize residual antimicrobial activity of antimicrobial peptides [SAAP-148 and pexiganan; 1% (wt/v) in PBS], antibiotics [mupirocin (Bactroban) and fusidic acid (Fucidin) in ointments; 2% (wt/wt))] and disinfectants [2% (wt/wt) silver sulfadiazine cream (SSD) and 0.5% (v/v) chlorhexidine in 70% alcohol].MethodsHomogenates of human skin models that had been exposed to various antimicrobial agents for 1 h were pipetted on top of Methicillin-resistant Staphylococcus aureus (MRSA) on agar plates to determine whether the antimicrobial agents display residual activity.To determine the optimal concentration of SPS for neutralization, antimicrobial agents were mixed with PBS or increasing doses of SPS in PBS (0.05–1% wt/v) and then 105 colony forming units (CFU)/mL MRSA were added. After 30 min incubation, the number of viable bacteria was assessed. Next, the in vitro efficacy of SAAP-148 against various gram-positive and gram-negative bacteria was determined using PBS or 0.05% (wt/v) SPS immediately after 30 min incubation of the mixture. Additionally, ex vivo excision wound models were inoculated with 105 CFU MRSA for 1 h and exposed to SAAP-148, pexiganan, chlorhexidine or PBS for 1 h. Subsequently, samples were homogenized in PBS or 0.05% (wt/v) SPS and the number of viable bacteria was assessed.ResultsAll tested antimicrobials displayed residual activity in tissue samples, resulting in a lower recovery of surviving bacteria on agar. SPS concentrations at ≥0.05% (wt/v) were able to neutralize the antimicrobial activity of SAAP-148, pexiganan and chlorhexidine, but not of SSD, Bactroban and Fucidin. Finally, SPS-neutralization in in vitro and ex vivo efficacy tests of SAAP-148, pexiganan and chlorhexidine against gram-positive and gram-negative bacteria resulted in significantly higher numbers of CFU compared to control samples without SPS-neutralization.ConclusionsSPS was successfully used to neutralize residual activity of SAAP-148, pexiganan and chlorhexidine and this prevented an overestimation of their efficacy.

Preliminary effect observation on the application of micro-negative pressure in children with small-area deep partial-thickness burn

Objective: To preliminarily observe the effects of application of micro-negative pressure in children with small-area deep partial-thickness burn. Methods: From January 2016 to August 2018, 64 children with small-area deep partial-thickness burn who were admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University were recruited in this prospective randomized controlled study. According to the random number table, they were divided into negative pressure group [18 boys and 14 girls, aged (3.9±1.6) years with total burn area of (5.5±2.2)% total body surface area (TBSA)] and conventional group [20 boys and 12 girls, aged (3.8±1.7) years with total burn area of (5.8±1.6)% TBSA], with 32 patients in each group. After admission, simple debridement was performed in the patients of 2 groups. After that, the children in negative pressure group were treated with micro-negative pressure with negative pressure material replaced every 3 to 5 days. Children in conventional group were treated with silver sulfadiazine cream with dressing change every other day. On post injury day (PID) 14 and 21, general wound observation was performed, the wound healing rate was calculated, the exudates from the wounds were cultured and the positive detection rate was calculated. The number of patients requiring surgical skin grafting was recorded and the rate of surgical skin grafting was calculated, and the complete wound healing time was recorded in the patients of 2 groups. Scar formation was evaluated by the Vancouver Scar Scale (VSS) in 3, 6, and 12 months after wound healing. Data were processed with chi-square test, t test, Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) On PID 14, all the necrotic tissue in the wounds of patients in negative pressure group was removed, with few exudates, and most of the wounds had been epithelialized; most of necrotic tissue in the wounds of patients in conventional group was removed, with more exudates and smaller wound healing area than those in negative pressure group. On PID 21, most of the wounds of patients in negative pressure group were healed, and the exudates were rare, while the wound healing area of patients in conventional group was significantly smaller than that in negative pressure group with more exudates. (2) On PID 14 and 21, the wound healing rates [(49.8±3.3)% and (95.8±2.4)%] of patients in negative pressure group were significantly higher than those in conventional group [(40.0±3.2)% and (75.3±2.5)%, t=11.899, 33.461, P<0.01]. (3) On PID 14 and 21, the positive detection rates of wound bacteria of patients in negative pressure group were significantly lower than those in conventional group (χ(2)=6.275, 5.741, P<0.05). (4) The rate of surgical skin grafting of patients in negative pressure group was significantly lower than that in conventional group (χ(2)=5.333, P<0.05). (5) The complete wound healing time of patients in negative pressure group [(23.9±2.3) d] was significantly shorter than that in conventional group [(27.9±1.8) d, t=-7.806, P<0.01]. (6) In 3, 6, and 12 months after wound healing, the VSS scores [(6.9±1.8), (5.6±1.4), (3.4±1.5) points] of patients in negative pressure group were significantly lower than those in conventional group [(9.0±1.5), (7.4±2.0), (5.7±1.6) points, t=-4.987, -4.127, -5.988, P<0.01]. Conclusions: In comparison with routine dressing change, the treatment of application of micro-negative pressure in children with small-area deep partial-thickness burn can significantly improve the wound healing rate and rate of surgical skin grafting, decrease the wound infection rate, shorten the wound healing time, and improve the wound healing quality.

Fabrication of Electrospun Probiotic Functionalized Nanocomposite Scaffolds for Infection Control and Dermal Burn Healing in a Mice Model.

The importance of microbiota paves the way to use microbial cells as medicines to treat pathobiomic diseases. This study reported the fabrication of probiotic (Enterococcus mundtii QAUEM2808)-functionalized nanocomposite scaffolds of poly(vinyl alcohol)/poly(vinylpyrrolidone)/glycerol via electrospinning. Scanning electron microscopy, Fourier transform infrared spectroscopy, and thermogravimetric analysis resolved the living composite structure and supported the encapsulation of E. mundtii throughout the nanostructured (318 ± 12 nm) fibers of bioscaffold membranes. The shelf life evaluation of 4-week-old samples supported that bioscaffolds showed an enhancement in probiotic survival count by 2.78 ± 0.10 log10 colony-forming units (cfu) versus counterpart biodispersion. The swelling and antagonistic evaluation showed that a bioscaffold is degradable in a simulated wound fluid which is essential for activation of probiotic strains to antagonize infection-causing Gram-positive and Gram-negative pathogens. A second-degree contact burn was made on the dorsum of male BALB/c mice (n = 30). The wounds were left open for 2 days to mimic burn contamination, and the mice were randomized into negative (untreated), positive (silver sulfadiazine cream), vehicle (biodispersion and nanoscaffold), and experimental bioscaffold groups (n = 6/group). These treatments were applied on 2, 6, 10, and 14 days postburn. A comparative wound closure, histopathology, and wound microbial evaluation demonstrated that the bioscaffolds accelerate epithelialization, collagen deposition, and hair follicle formation, inhibit harmful bacteria, and provide interference benefits. In particular, the probiotic active bioscaffold membrane could serve as a novel candidate to control infections and speed up the healing of burn wounds.

Antibiotic-Containing Agarose Hydrogel for Wound and Burn Care.

Wound infections cause inflammation, tissue damage, and delayed healing that can lead to invasive infection and even death. The efficacy of systemic antibiotics is limited due to poor tissue penetration that is especially a problem in burn and blast wounds where the microcirculation is disrupted. Topical administration of antimicrobials is an attractive approach because it prevents infection and avoids systemic toxicity, while hydrogels are an appealing vehicle for topical drug delivery. They are easy to apply to the wound site by being injectable, the drug release properties can be controlled, and their many characteristics, such as biodegradation, mechanical strength, and chemical and biological response to stimuli can be tailored. Hydrogels also create a moist wound environment that is beneficial for healing. The purpose of this study was to formulate an agarose hydrogel that contains high concentrations of minocycline or gentamicin and study its characteristics. Subsequently, the minocycline agarose hydrogel was tested in a porcine burn model and its effect as a prophylactic treatment was studied. The results demonstrated that 0.5% agarose in water was the optimal concentration in terms of viscosity and pH. Bench testing at room temperature demonstrated that both antibiotics remained stable in the hydrogel for at least 7 days and both antibiotics demonstrated sustained release over the time of the experiment. The porcine burn experiment showed that prophylactic treatment with the agarose minocycline hydrogel decreased the burn depth and reduced the number of bacteria as efficiently as the commonly used silver sulfadiazine cream.

ZOUSH Ointment with the Properties of Antibacterial Moreover, Burn Wound Healing

Pseudomonas aeruginosa is a third hospital infection agent, and it is the second essential factor in wound infections. Despite many scientific advances in the treatment of burns, burn is one of the significant public health problems worldwide, particularly in developing countries. In this study, natural ointment ZOUSH was formulated with alcoholic extracts of Satureja khuzestaniea, Zataria multiflora and Mentha Mozaffariani Jamzad with Honey, and Polyurethane. A comparison between ZOUSH ointment and antibiotic was made by the disc diffusion method. PCR techniques carried out to confirm the genes exoS, lasA, and lasB, the housekeeping genes gyrA and fabD were used as a control. The burn wound was created by Ian Allen Holder method. The treatment was performed in 20 days, and the size of the burn was measured. Silver sulfadiazine ointment was considered as a positive control. The results indicated that 10, 13, 17 and 20 µg concentration of ZOUSH ointment have 12, 14, 15, 18 mm inhibition zone. Also, ZOUSH ointment can decrease the size of the wound and has wound healing properties. Due to the effectiveness of ZOUSH ointment on the size of burn wound and its antibacterial properties on P. aeruginosa, this ointment is recommended for the treatment of burn wounds.