Topical Silver Research Articles

Falsely Elevated Triglyceride and Lipase Levels Due to Hyperglycerolemia in a Burn Patient Treated with Topical Silver Sulfadiazine

Pseudohypertriglyceridemia is an overestimation of serum triglyceride levels, potentially leading to an inaccurate diagnosis of hypertriglyceridemia. This can result from hyperglycerolemia, which interferes with enzymatic measurement methods. Hyperglycerolemia may arise from drugs or genetic glycerol kinase defects. We present a case of a severely burned patient with very high triglyceride levels (up to 5,696 mg/dL) that was resistant to lipid-lowering treatment, identified during the work up for pancreatitis associated with elevated lipase levels. Despite the very high triglyceride levels reported in the laboratory results, the standing plasma showed clear plasma, with no significant peak of pre-beta lipoprotein observed on serum lipoprotein electrophoresis. Serum apolipoprotein B levels were low, and urine triglyceride levels were high. This case confirms that very high serum glycerol levels caused the falsely elevations of triglyceride and lipase levels, resulting from hyperglycerolemia induced by the massive topical application of silver sulfadiazine cream (containing glycerine and glyceryl stearate) to the severely burned wound, which interfered with the laboratory assays. Triglyceride and lipase levels dramatically decreased after reducing the dose of silver sulfadiazine cream. No genetic defects related to glycerol kinase deficiency were identified.

Development of topical silver nano gel formulation of Bixin: Characterization, and evaluation of anticancer activity

ObjectiveSkin cancer refers to the pathological condition characterized by the proliferation of atypical skin cells in an uncontrolled manner. Plant-based products such as bixin although show promising anticancer properties, but maintaining their stability in a formulation is a difficult task. The objective of the research is to formulate a silver nanoparticle gel preparation of bixin and evaluate its anticancer properties. MethodsThe extract from Bixa orellana seed was prepared by hot extraction technique to isolate the active ingredient, bixin. A green synthesis approach was utilized for preparing the silver nanoparticle gel of bixin (BOAgNPs). Characterization of silver nanoparticles was done using FTIR, scanning electron microscopy, compatibility study, homogeneity testing, pH evaluation, and drug content determination. The in-vitro anticancer activity was performed using cell lines (B16F10) and in-vivo by chemical carcinogen (7,12-dimethylbenz (a) anthracene) in mice. ResultsThe BOAgNPs-loaded topical gel was found to be homogeneous (clear orange color) and pH-compatible (pH ≈ 6.66) with the skin. The characterization studies indicated the presence of all functional groups in the formulation. An optimized batch of bixin-nano gel showed about 60% inhibitory effects on B16F10 cell lines (in-vitro activity) when equated with a reference drug, 5-fluorouracil. The in-vivo anticancer study suggested suppression of tumorigenesis and promotion of the healing process with bixin-nano gel application on the skin. ConclusionThe results suggested the promising anticancer property of bixin when formulated in silver nanoparticle gel. The preparation of silver particles nano gel with bixin might provide an effective alternative option for treating skin cancers, provided more research complements the findings of the present study.

Comparison between silver nitrate and table salt in the treatment of umbilical granuloma.

Objective: To compare the efficacy of table salt with silver nitrate in the treatment of umbilical granuloma presenting to the neonatal unit/paediatric department KTH. Study Design: Randomized Controlled Trial Setting: Neonatal Unit of Khyber Teaching Hospital. Period: November 2019 to November 2022. Methods: A total of 120 patients who presented to the neonatal unit/paediatric department, aged 15-60 days were enrolled in this study via consecutive sampling. Seventy-five patients each, were allocated to two groups, Group A (common salt) and Group B (silver nitrate). Sixteen patients from Group A whereas, in Group B, 17 patients were lost to follow-up. Results: A total of 58 out of the remaining 117 patients were female whereas 59 patients were male. Treatment response was recorded for both groups. The cure rate was greater among Group B (93%) as compared to Group A (88%) but there was no statistically significant difference between Group A and B in treatment response (p= 0.35). Conclusion: Table salt is a cheaper, easily accessible, and safe alternative to topical silver nitrate in the treatment of umbilical granuloma.

Effect of Topical Silver Nanoparticle Formulation on Wound Bacteria Clearance and Healing in Patients With Infected Wounds Compared to Standard Topical Antibiotic Application: A Randomized Open-Label Parallel Clinical Trial.

Infected wounds pose a special challenge for management, with an increased risk of wound chronicity, systemic infection, and the emergence of antibiotic resistance. Silver nanoparticles have multimodal effects on bacteria clearance and wound healing. This study aimed to document the efficacy of a topical silver nanoparticle-based cream on bacteria clearance and wound healing in infected wounds compared to Mupirocin. This open-label parallel randomized clinical trial allocated 86 participants with infected wounds (culture-positive) into Kadermin, silver nanoparticle-based cream arm (n=43) and Mupirocin arm (n=43) and documented the swab culture on day 5 and wound healing at day 28, along with periodic wound status using the Bates-Jensen Wound Assessment Tool. Patients received oral/systemic antibiotics and other medications for underlying diseases. The intention-to-treat principle was adopted for data analysis using the chi-square and Student t tests to document the differences between groups according to variable characteristics. All participants completed the follow-up. On day 5, wound bacteria clearance was observed in 86% and 65.1% of the participants in the Kadermin and Mupirocin arms, respectively (p=0.023). At day 28, complete wound healing was observed in 81.4% and 37.2% of the participants in the Kadermin and Mupirocin arms, respectively (p≤0.001). No local or systemic adverse event or local reaction was observed in any of the participants. Kadermin, the silver nanoparticle-based cream, has better efficacy in achieving faster wound bacteria clearance and healing in infected wounds compared to Mupirocin. This may have relevance for its use as an antibiotic-sparing agent in wound management.

Severe BCG immune reconstitution inflammatory syndrome lymphadenitis successfully managed with pre-antiretroviral counseling and a non-surgical approach: a case report

BackgroundBacillus Calmette-Guérin (BCG) reactions are the most common cause of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive infants who initiate antiretroviral therapy (ART). There is limited evidence regarding the incidence of BCG-IRIS; however, reports from outpatient cohorts have estimated that 6–9% of infants who initiated ART developed some form of BCG-IRIS within the first 6 months. Various treatment approaches for infants with BCG-IRIS have been reported, but there is currently no widely accepted standard-of-care.Case PresentationA 5-month-old male HIV-exposed infant BCG vaccinated at birth was admitted for refractory oral candidiasis, moderate anemia, and moderate acute malnutrition. He had a HIV DNA-PCR collected at one month of age, but the family never received the results. He was diagnosed with HIV during hospitalization with a point-of-care nucleic acid test and had severe immune suppression with a CD4 of 955 cells/µL (15%) with clinical stage III disease. During pre-ART counseling, the mother was educated on the signs and symptoms of BCG-IRIS and the importance of seeking follow-up care and remaining adherent to ART if symptoms arose. Three weeks after ART initiation, he was readmitted with intermittent subjective fevers, right axillary lymphadenopathy, and an ulcerated papule over the right deltoid region. He was subsequently discharged home with a diagnosis of local BCG-IRIS lymphadenitis. At six weeks post-ART initiation, he returned with suppurative lymphadenitis of the right axillary region that had completely eviscerated through the skin without signs of disseminated BCG disease. He was then started on an outpatient regimen of topical isoniazid, silver nitrate, and oral prednisolone. Throughout this time, the mother maintained good ART adherence despite this complication. After 2.5 months of ART and one month of specific treatment for the lymphadenitis, he had marked mass reduction, improved adenopathy, increased CD4 count, correction of anemia, and resolution of his acute malnutrition. He completely recovered and was symptom free two months after initial treatment without surgical intervention.ConclusionsThis case details the successful management of severe suppurative BCG-IRIS with a non-surgical approach and underlines the importance of pre-ART counseling on BCG-IRIS for caregivers, particularly for infants who initiate ART with advanced HIV.

Effect of silver colloid dressing over conventional dressings in diabetic foot ulcer: A prospective study.

Topical silver treatments and silver dressings are increasingly being utilized for the local treatment of wounds; nevertheless, the evidence for their usefulness is unclear. The aim of this study was to investigate the impact of conventional dressings and silver colloid dressing on diabetic foot ulcers (DFU) with and without compression therapy. This prospective, double-blind experiment included 50 patients with non-ischemic DFUs, split into two groups of 25 patients each. The study was conducted for a period of six months. The primary endpoint was to evaluate the entire epithelialization (total healing) of all ulcers on the study leg. The ulcer area significantly decreased in the colloidal silver group (67.77 ± 17.82%) compared to the conventional saline group (21.70 ± 23.52%). When compared to the conventional group, the colloidal silver group required considerably fewer days to reach the endpoint (23.15 ± 8.15 days vs. 48.35 ± 18.07 days), and by day 14, ulcer area reduction (from 100%) was greater (48% in the silver group vs. 89.69% in the conventional group). In managing DFUs, unstructured hydrogel wound dressings using silver colloids based on ionic silver are more effective than regular saline dressings since they heal wounds more quickly in fewer days while also drastically reducing ulcer areas over time.

Formulation and Evaluation of a Topical Spraybased Foam Containing Aloe Vera and Silver Sulfadiazine to Treat First and Second-degree Skin Burns

Formulation and Evaluation of a Topical Spraybased Foam Containing Aloe Vera and Silver Sulfadiazine to Treat First and Second-degree Skin Burns

Green Synthesis of Silver Nanoparticle Using Aqueous Leaf Extract of Barleria noctiflora and its Bioactive Efficacy

For millennia, silver has been known to have powerful antibacterial effects. Topical silver dressings are now commonly used to treat infections in burns, open wounds, and persistent ulcers. Because pathogenic organisms evolve on a daily basis as a result of mutation and antibiotic resistance, the manufacture and investigation of nanoparticles for use in antibacterial garments, burn ointments, and medical device coatings is an important industrial topic of nanoscience. This is the first study on the synthesis of silver nanoparticles from leaf extract of the medicinal plant Barleria noctiflora. Through the use of FT-IR, UV-visible spectrum analysis, XRD analysis, SEM EDAX, and antimicrobial potential, the bioreduced nanoparticles were discovered and verified. The greatest absorption peak in the UV-visible spectrum examination was seen at 480 nm for the silver nanoparticles. Twelve distinct peaks were identified in the FTIR spectra of biogenic AgNPs, located at 3127.21, 1624.74, 1400.35, 1155.96, 1021.11, 906.70, 825.31, 718.73, 669.69, 538.93, 457.21, and 417.49 cm-1. Peaks at 2θ values of 10.545, 19.000, 21.137, 22.033, 23.370, 26.691, 31.507, and 33.747, corresponding heights of 23.40, 235.26, 750.78, 357.58, 335.93, 171.19, 186.87, and 115.38cts, respectively, indicated by XRD analysis that the silver particles generated in our experiments were nanocrystals. The silver nanoparticles were tested with "d" spacing values of 8.38940, 4.67087, 4.20328, 4.03422, 3.80651, 3.33986, 2.83949, and 2.65601. SEM spectral analysis revealed oval AgNPs with a size range of 20 m. Metallic nanoparticles generated from Barleria noctiflora were tested for antibacterial activity against gram-positive and gram-negative pathogens such as E. Coli, Staphylococcus aureus, and the fungi Aspergillus niger and Candida albicans using the disc diffusion method. Surprisingly, metallic Ag nanoparticles had strong inhibitory zones against the selected illnesses.

What is the Best Management for Geriatric Epistaxis? A Comprehensive Systematic Review and Meta-analysis

Background: Given the importance of epistaxis in elder patients, this systematic review was conducted to determine the best non-surgical treatment of epistaxis in elder patients. Methods: A systematic search of references was performed to investigate non-surgical methods in administering epistaxis in elder people in March 2022 for relevant articles. Results: Among 1613 retrieved articles in the initial search, 28 studies were included, and the mean re-bleeding in 18 studies was 18%. Regarding the treatment methods, 35.7%, 14.3%, 10.7%, and 10.7% used nasal packing, intranasal topical tranexamic acid, silver nitrate, and Floseal® treatment, respectively. The highest success rate was related to topical tranexamic acid compared to topical oxymetazoline spray (Odds ratio [OR]: 6.50, 95% confidence interval [CI]: 1.54-27.49, P=0.011), followed by nasal compression with tranexamic acid compared to the placebo. Conclusion: It seems that tranexamic acid has a beneficial effect on controlling epistaxis in the elderly. However, well-designed large randomized controlled trials are indicated for an accurate conclusion.

515 Retrospective Review of Silver Sulfadiazine use in Sulfa Allergic Patients at a Regional Burn Center

Abstract Introduction Plastic Surgeons are commonly called upon to evaluate wounds. Most wounds in otherwise healthy individuals will heal with minimal intervention, however in patients with comorbid conditions and systemic disease the incidence of nonhealing wounds is much more prevalent. Silver sulfadiazine is the most common topical antimicrobial used in burn management. Current literature recommends avoiding the use of silver sulfadiazine in burn patients with sulfa allergies. The intent of this retrospective review is to examine the safety of silver sulfadiazine use in documented sulfa allergic burn patients at a level one trauma hospital and regional burn center. Methods After obtaining IRB approval for electronic chart review of patients who were treated with silver sulfadiazine, charts were reviewed and exclusion criteria applied. Patients included in the study had documented burns treated by burn team providers, application of topical silver sulfadiazine for primary burn management, and a documented sulfa allergy. Chart review identified 70 patients who met the stated criteria out of 2,644 patients treated over a five year period. Results None of the 70 patients with documented sulfa allergies suffered adverse reactions to silver sulfadiazine use for primary burn care. There were no documented systemic or anaphylactic reactions, hives, or additional adverse reactions after administration. No cessation of the medication was documented due to intolerance. Conclusions Silver sulfadiazine is a common topical antimicrobial treatment in acute burn care. It has previously been avoided in patients with documented sulfa allergy due to concern for cross reactivity. However, in this population of patients, there were no documented adverse reactions to topical silver sulfadiazine. This study suggests that withholding topical sulfonamides from patients with prior reactions to antibacterial sulfonamides may not be clinically justified. Applicability of Research to Practice We present evidence in our retrospective review that administration of topical silver sulfadiazine for primary burn care can be done in a safe manner, without adverse allergic reactions.

764 Comparison of Topical Silver Sulfadiazine and Triple Antibiotic Ointment in a Porcine PT Burn Model

Abstract Introduction The standard of care for partial thickness burns is topical antibiotics or occlusive dressing. Silver Sulfadiazine (SSD) emerged at a time of burn wound infection and sepsis prevalence and is now the most used topical worldwide. Despite its antimicrobial benefits, SSD has been shown to inhibit keratinocytes and there is concern that it might delay wound healing. This study compared time to complete wound closure and reepithelialization in partial thickness porcine burns treated with SSD, triple antibiotics ointment or petrolatum ointment Methods We created 21 deep partial thickness (DPT) burns per animal on the backs and flanks of 3 anesthetized domesticated pigs (30-35 kg) using an established vertical progression model (aluminum bar preheated to 80° C for 20s). In each pig, burns were randomly assigned SSD, triple antibiotic ointment, or petrolatum ointment (in a 1:1:1 ratio) applied daily for two weeks followed by twice weekly for another 2 weeks. Healing progression was measured by wound digital photography and punch biopsies to assess gross wound closure, reepithelization and scar depth respectively. Results The median (IQR) days to complete wound closure were 17 (17-21), 17 (14-21), and 21 (17-21) for wounds treated with SSD, petrolatum and triple antibiotic ointment respectively (p=0.06). The mean percentage of wound reepithelization at days 10, 14, 17, 21, and 28 for wounds treated with, SSD, petrolatum, and triple antibiotic ointment were 10%±20 vs. 8%±14 vs. 3%±12 (p=0.34), 45%±49 vs. 37%±44 vs. 48%±42 (p=0.74), 82%±38 vs. 86%±20 vs. 90%±27 (p=0.7), 74%±38 vs. 65%±50 vs. 93%±16 (p=0.049), and 92%±17 vs. 91%±28 vs. 98%±5 (p=0.4). The mean scar depth was 3.9 (1.1), 4.2 (0.9), and 3.4 (0.9) mm for wounds treated with SSD, petrolatum, and triple antibiotic ointment respectively (p=0.07). RMANOVA analysis showed significant change over time (p< 0.001) and a near significant difference between groups (p=0.054). On macroscopic analysis, appreciable pseudoeschar formation and erythematous allergic reactions were identified on wounds treated with SSD and triple antibiotic ointment respectively. Conclusions No significant differences in wound healing were found between groups in this porcine DPT burn model. SSD did not delay closure. Hypersensitivity to topical triple antibiotics was common. Applicability of Research to Practice This study provides insight into the topical ointment standard of care for burns and helps establish the standard comparator topical treatment for future preclinical and clinical studies.

In Vivo Study of the Effects of Propranolol, Timolol, and Minoxidil on Burn Wound Healing in Wistar Rats.

Propranolol, timolol, and minoxidil have all shown benefits in treatment of burn injury and other skin wounds. The study evaluated their effects on full-thickness thermal skin burns in a Wistar rat model. Performed on 50 female rats; two dorsal skin burns were created on each animal. On the next day, the rats were divided into 5 groups (n=10); each has received a specific treatment daily for 14 days: group I - topical vehicle (control), group II - topical silver sulfadiazine (SSD), group III - oral propranolol (5.5mg) associated with topical vehicle, group IV - topical timolol 1% cream, group V - topical minoxidil 5% cream. Wound contraction rates, malondialdehyde (MDA), glutathione (GSH, GSSG), and catalase activity in skin and/or serum were evaluated, and histopathological analyses were performed. Propranolol did not show advantages in necrosis prevention and wound contraction and healing, and did not reduce oxidative stress. It impaired keratinocyte migration, and promoted ulceration, chronic inflammation, and fibrosis, yet reducing the necrotic zone. Timolol prevented necrosis and promoted contraction and healing, increased antioxidant capacity and promoted keratinocyte migration and neo capillarization in comparison to the other treatments. Minoxidil reduced necrosis and enhanced contraction, resulting in positive outcomes after 1 week of treatment regarding local antioxidant defense, keratinocyte migration, neo capillarization, chronic inflammation, and fibrosis rates. However, after 2 weeks, it resulted in contrasting outcomes. In conclusion, topical timolol promoted wound contraction and healing, reducing local oxidative stress and improving keratinocyte migration, bringing arguments for potential benefits in skin epithelization.

Althaea officinalis L. Extract Heals Skin Wounds in Second-Degree Burns in Mice

Background: Burns are one of the most common injuries; however, there are few medications to repair burned skin. Although antibacterial drugs such as topical silver sulfadiazine may prevent wound infections, they usually cannot accelerate skin healing. Marshmallow (Althaea officinalis L.) has long been used in Iranian traditional medicine to deal with skin burns. Objectives: The present study aimed to evaluate the effect of hydroalcoholic and aqueous extract of A. officinalis on the histopathologic parameters of second-degree burns in mice. Methods: The mice were randomly divided into nine groups (n = 6), including control and treatment groups. Experimental second-degree burns were induced on the dorsal skin of the mice by a metal plate (2 cm in diameter) under general anesthesia. Control and treatment groups were treated twice a day for 21 days topically. Normal saline was used for the control group, and hydroalcoholic and aqueous extracts of A. officinalis in three concentrations (1%, 2%, and 4%) were used for the treatment groups. All preparations were made in a hydrogel base. Finally, the histopathological parameters of the burned skin, including polymorphonuclear (PMN) migration, epithelialization, angiogenesis, and collagenization, were scored, and the total score of wound healing was calculated. Results: The findings showed that topical application of hydroalcoholic or aqueous extracts of A. officinalis accelerated the wound healing process. They reduced PMN migration, collagenization, epithelialization, and angiogenesis scores compared to the control group. There was a significant difference between the 4% hydroalcoholic extract group and the normal saline group. Conclusions: Althaea officinalis may have been used as an adjunct medication to accelerate wound healing in skin burns.

Topikalne farmaceutske formulacije za negu kože izložene jonizujućem zračenju

Radiotherapy as the application of ionizing radiation is one of the main current therapeutic modalities for cancer. However, one of the most frequent adverse effects of this therapeutic strategy is radiodermatitis, which significantly affects quality of patients' lives. Nowadays, there is no consensus on the appropriate therapy of radiodermatitis, however there are basic recommendations that should be followed. The aim of this study was to make a review of current recommendations during radiotherapy for the prevention of radiodermatitis through application or avoidance of application of certain topical pharmaceutical formulations. Most studies proposed the adequate personal hygiene as a general preventive measure. Basic recommendations also include wearing loose-fitting clothing, using an electric shaver, sunscreens, moisturizers, and avoiding alcohol and cigarettes. According to the Multinational Association of Supportive Care in Cancer (MASCC), the only recommendation for the prevention and treatment of radiodermatitis is gentle washing using mild soap, as well as the use of topical steroids and silver sulfadiazine. Some studies report the possibility of using photobiomodulatory therapy in the prevention of radiodermatitis, as well as non-corticosteroid creams based on aloe, hyaluronic acid, calendula and comfrey. The use of comedogenic topical preparations, those containing alcohol, benzoyl peroxide and/or alpha-hydroxy acids, as well as those containing potential contact allergens and irritants, should be avoided. Adequate guidelines supported by strong evidence and consensus do not exist, and many recommendations were later refuted. Therefore, further research in this field is necessary to find a satisfying solution for an issue of radiation dermatitis.

Topical silver nanoparticles reduced with ethylcellulose enhance skin wound healing.

Silver nanoparticles (G-AgNPs) improve wound healing by promoting skin cell proliferation and differentiation. Therefore, G-AgNPs could act as drug carriers and wound healers in biomedicine. The current study aimed to improve skin wound healing using natural, safe G-AgNPs. The G-AgNPs were reduced withethylcellulose (EC) and incorporatedinto an oil-in-water cream base. The size, charges, and wavelength were used to characterize the prepared G-AgNPs. Further, the transmission electron microscope (TEM) and the scanning electron microscope (SEM) were used to provide the shape of G-AgNPs. Moreover, the skin wound healing was evaluated with the appropriate histopathological techniques in a mouse model withskin injury toprovethe curative effects of G-AgNPs which was conducted for 15 days on 45 adult male albino rats. The effectiveness of G-AgNPs-EC cream for treating surgical skin wounds was assessed by histopathological (HP) examination of hematoxylin and eosin (H&E) stained sections. The produced G-AgNPs-EC showed a size of 183.9 ± 0.854 nm and a charge of -14.0 ± 0.351 mV. UV-VIS spectra showed a strong absorption of electromagnetic waves in the visible region at 381 nm. Furthermore, the TEM and SEM showed rounded NPs in nano size of the prepared G-AgNPs-EC. The G-AgNPs cream was pivotal in enhancing wounds' healing properties, improving the formation of wound granulation tissue, and enhancing the proliferation of epithelial tissue in rats. The current study showed that G-AgNPs-EC is a new skin wound healer that speeds up healing.

Topical Use of Heparin and Silver Sulfadiazine Cream in the Treatment of Second Degree Burn in Children: A Comparative Study

Introduction: Burn is a complex disease process, a trauma to physique as well as psyche. Visible disfigurement caused by burns translates into an altered pattern of socialization which in turn can have serious psychological ramifications. Patients with burns require immediate specialized care in order to minimize morbidity and mortality. So, the important part of the management of burns is wound management. Objectives: To assess the efficacy of topical heparin and silver sulfadiazine cream in burn wound management. Methods: Prospective comparative interventional study was carried out at the Department of Burn & Reconstructive Surgery, Faculty of Paedicatric Surgery, Bangladesh Shishu Hospital and Institute. A total 42 patients were included in this study after fulfilment of all selection criteria during the study period. Patients were randomly selected into two groups. In group A (n=21) patients were treated with topical heparin and in group B (n=21) patients were treated with silver sulfadiazine cream. Results: The mean pain relief time was 1.76±0.54 days in group A and 5.52±0.98 days in group B. The difference was statistically significant (p<0.05). The mean wound healing time was 4.62±0.86 days in group A and 8.0±1.97 days in group B. The difference was statistically significant (p<0.05). The mean hospital stay was 5.57±0.75 days in group A and 8.10±1.97 days in group B. The difference was statistically significant (p<0.05). Conclusion: Topical use of heparin is safe and more effective than silver sulfadiazine cream in the management of second-degree burns in children.

Effect of the combination of composite skin grafting and recombinant human basic fibroblast growth factor on plastic surgery for extensive sc ars after burns

Purpose: To investigate the effect of combined use of composite skin grafting and recombinant human basic fibroblast growth factor (rh-bFGF) on plastic surgery for extensive burn scars, and its influence on wound healing and inflammatory responses in patients.
 Methods: Hospital records of 120 patients who underwent extensive scar plastic surgery after burns in Hanchuan People’s Hospital from February 2019 to February 2020 were retrospectively analyzed. The patients were equally assigned to study group (STG) and control group (COG), based on the order of admission. All patients received composite skin grafting surgery and post-surgery topical silver sulphadiazine cream regularly, while those in study group (STG) received additional treatment with rh-bFGF spray on the wound surfaces. Scar scores, degree of wound healing, populations of fibrocytes and capillaries, levels of vascular endothelial growth factor (VEGF) and transforming growth factor-β1 (TGF-β1), and activities of lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) were evaluated.
 Results: Patients in STG had significantly better scar scores, shorter mean wound healing time, higher mean degree of wound healing, higher scores on inflammatory reactions near the wounds, and higher populations of fibrocytes and capillaries, when compared with patients in COG group (p < 0.001). After surgery, there were lower levels of VEGF and TGF-β1, and lower levels of activities of LDH and SDH in STG than in COG group (p < 0.001).
 Conclusion: Rh-bFGF accelerates the proliferation of wound tissue, improves local microcirculation, regulates inflammatory response, and enhances wound healing in burn scar patients when used in combination with composite skin grafting. Therefore, Rh-bFGF has a potential for enhanced management of burn scars.

Acute radiation dermatitis among patients with nasopharyngeal carcinoma treated with proton beam therapy: Prognostic factors and treatment outcomes.

A high incidence of severe acute radiation dermatitis (ARD) has been reported for cancer patients treated by proton beam therapy (PBT). This observational study investigated the prognostic factors and treatment outcomes of ARD among patients with nasopharyngeal carcinoma (NPC) treated with PBT. Fifty-seven patients with newly diagnosed NPC and treated with PBT were enrolled. ARD was recorded weekly based on the criteria of Common Terminology Criteria for Adverse Events version 4.0 at treatment visits (1st to 7th weeks) and 1 week (8th week) and 1 month (11th week) after the completion of PBT. The maximum ARD grade was 1, 2, and 3 in 26 (45.6%), 24 (42.1%), and 7 (12.3%) of the patients, respectively. The peak incidence of grade 2 and 3 ARD was observed during the period of the 6th to 8th weeks. Treatment of ARD included topical corticosteroid alone in 24 (42.1%) patients, topical corticosteroid plus silver sulfadiazine in 33 (57.9%) patients, and non-adhering silicone dressing to cover severe skin wound area in 25 (43.8%) patients. In the 11th week, most grade 2 and 3 ARD had disappeared and 93.0% of the patients had ARD of grade 1 or lower. In the binary logistic regression model, we identified habitual smoking (odds ratio [OR]: 5.2, 95% confidence interval [CI]: 1.3-18.8, P= .012) and N2 to N3 nodal status (OR: 4.9, 95% CI: 1.6-15.4, P= .006) as independent predictors of grade 2 and 3 ARD. The results show ARD is a major concern for patients with NPC treated with PBT, especially those with habitual smoking or advanced nodal status. Topical corticosteroid, silver sulfadiazine, and non-adhering silicone dressing are effective for treating ARD induced by PBT.

Topical Wound Therapy Products With Ionic Silver: A Technologic Analysis.

The purpose of this technologic analysis was to review use of ionic silver as a component of topical wound therapy products. Published literature from a variety of fields related to ionic silver and its use in topical wound therapy products was reviewed and a summary of common commercially available wound care products containing ionic silver was generated, along with general recommendations for use. Safety information from both manufacturer guidelines and the Manufacturer and User Facility Device Experience (MAUDE) database is summarized. Various formulations of ionic silver products are used for topical treatment of wounds. Antimicrobial activity varies according to the specific silver formulation and type of microorganisms in the wound bed. In vitro evidence suggests that some bacterial strains may be developing resistance to ionic silver. Improved knowledge of the benefits and safety precautions associated with topical silver preparations can guide its application to topical therapy for wound healing.

The Effect of Ethanolic Extract of Moringa oleifera Leaves on the Macrophage Count and VEGF Expression on Wistar Rats with Burn Wound

Background: One modality type of burn wound therapy is topical silver sulfadiazine. Recently, research about topical herb medicine has grown. Moringa oleifera (MO) is a kind of herb plant that has an anti-inflammation effect and has an influence on angiogenesis, so it tends to faster burn wound healing. This study aimed to prove the effect of ethanolic extract of Moringa oleifera leaves on the macrophage count and VEGF expression in Wistar rats with burn wounds.
 Methods: The research design that was used is "Randomized post-test with a control group." The study population used 24 male Wistar rats that were induced burn wounds and randomly divided into 4 groups which were given medicine topically once daily for 7 days. Treatment groups included: I (MO leaves extract 10%), II (SSD + MO leaves extract 10%), III (SSD), dan IV (pure vehiculum). Exudation was assessed macroscopically, while PMN and macrophage amount were assessed microscopically with Hematoxylin-Eosin. Data were analyzed and processed using hypothesis test One Way ANOVA – Post Hoc Bonferroni, Kruskal Wallis – Mann Whitney, and correlation test Spearman and Pearson with SPSS 25.0 program.
 Results: Significant difference obtained in macrophage amount between II group and IV group (p 0,000). There was no significant difference in VEGF expression. There was also no correlation between macrophage amount and VEGF expression.
 Conclusion: Ethanolic extract of Moringa oleifera leaves extract proved to be effective in decreasing macrophage cell count on Wistar rats with burn wounds.