RESUMEN
BACKGROUND: Burns are classified according to their mechanism of injury, depth, affected body area, affected region or part of the body, and extent of the lesions. Topical insulin modulates the healing process. However, studies evaluating the effects of topical insulin treatment on burns in human patients are lacking. PURPOSE: The purpose of this study was to investigate the effects of topical insulin on healing time of second-degree burns. METHODS: In this nonrandomized clinical trial, patients with second-degree burns were allocated to a control group (CG) or an intervention group (IG) in which wounds were treated with 1% silver sulfadiazine and topical insulin, respectively. RESULTS: Healing time was significantly shorter in the IG relative to the CG (9.1 ± 1.9 days and 12.7 ± 3.3 days, respectively; P < .05). The estimated burn area was similar in both groups (CG 1.44 ± 1.0%; IG 1.42 ± 0.53%). CONCLUSION: In this study, topical insulin reduced healing time in second-degree burns. Further investigation is warranted to support wider use in clinical practice.
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Administración Tópica , Quemaduras , Insulina , Cicatrización de Heridas , Humanos , Quemaduras/tratamiento farmacológico , Quemaduras/fisiopatología , Cicatrización de Heridas/efectos de los fármacos , Insulina/uso terapéutico , Insulina/administración & dosificación , Insulina/farmacología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Sulfadiazina de Plata/uso terapéutico , Sulfadiazina de Plata/farmacología , Sulfadiazina de Plata/administración & dosificación , Factores de TiempoRESUMEN
The insertion of topical antimicrobials in wound treatment represented an important role in patient management. Among these agents, silver sulfadiazine (AgSD), introduced in the therapy of wounds and burns in the 1960s, is considered the gold standard in treatment due to its mechanism of action, in addition to its proven efficacy and safety. The association of AgSD with polymers for the development of curative formulations has been reported. The evaluation of the physical-chemical properties of these systems with the aid of analytical techniques of characterization is essential for the determination of their activities, besides allowing the detection of possible incompatibilities between AgSD and polymers. Thus, this review presents the main techniques of physicochemical characterization used in the evaluation of systems containing AgSD with curative purposes in order to provide parameters to ensure the efficacy and safety of these new therapeutic options. Microscopic, thermoanalytical, and spectroscopic techniques, for example, provide information on system properties such as surface chemical composition, crystallinity, morphology, and thermal stability of curative formulations containing AgSD. These techniques are important in the selection of the most appropriate techniques during the development of a polymeric curative system containing AgSD, in addition to providing information for cost reduction of a possible scale-up and the establishment of methodologies for quality control of these systems to ensure their efficacy and safety.
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Antiinfecciosos Locales , Sulfadiazina de Plata , Humanos , Sulfadiazina de Plata/farmacología , Sulfadiazina de Plata/química , Vendajes , PolímerosRESUMEN
PURPOSE: To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings. METHODS: Wistar rats were used, divided into six treatments: saline (NaCl 0.9%); silver sulfadiazine 1%; Silvercel; Mepilex Ag; Aquacel Ag and Acticoat. The animals were monitored daily and euthanized at 7, 14 and 30 days after injury induction (DAI). RESULTS: At 7 DAI, necrosis/crust was greater in control, silver sulfadiazine and Mepilex Ag treatments, granulation tissue was induced by Aquacel Ag, polymorphonuclear infiltrate (PMN) infiltration was intensified by Mepilex Ag; mononuclear infiltrate (MN) infiltration and angiogenesis were increased by Silvercel. At 14 DAI, hemorrhage was decreased by Silvercel and Mepilex Ag, PMN infiltration increased by Acticoat. At 30 DAI, angiogenesis was greater in the Acticoat treatment and fibroblasts were increased by Acticoat and Mepilex Ag. Collagen was induced at 14 DAI by silver sulfadiazine and Aquacel Ag and, at 30 DAI, by silver sulfadiazine and Silvercel treatments. CONCLUSIONS: Silvercel and Acticoat presented better results than the other products. However, all the dressings were better than the control at some point during the process, and may contribute to the healing of partial thickness burns. Silvercel and Aquacel Ag treatments induced better cosmetic outcomes regarding wound closure and scarring.
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Quemaduras , Sulfadiazina de Plata , Ratas , Animales , Sulfadiazina de Plata/farmacología , Sulfadiazina de Plata/uso terapéutico , Plata , Carboximetilcelulosa de Sodio , Ratas Wistar , Vendajes , Quemaduras/tratamiento farmacológicoRESUMEN
The development of new treatments capable of controlling infections and pain related to burns continues to be a challenge. Antimicrobials are necessary tools, but these can be cytotoxic for regenerating cells. In this study, antibiotic-anesthetic (AA) smart systems obtained by ionic complexation of polyelectrolytes with ciprofloxacin and lidocaine were obtained as films and hydrogels. Ionic complexation with sodium alginate and hyaluronate decreased cytotoxicity of ciprofloxacin above 70% in a primary culture of isolated fibroblasts (p < 0.05). In addition, the relative levels of the proteins involved in cell migration, integrin ß1 and p-FAK, increased above 1.5 times (p < 0.05) with no significant differences in cell mobility. Evaluation of the systems in a deep second-degree burn model revealed that reepithelization rate was AA-films = AA-hydrogels > control films > no treated > reference cream (silver sulfadiazine cream). In addition, appendage conservation and complete dermis organization were achieved in AA-films and AA-hydrogels. Encouragingly, both the films and the hydrogels showed a significantly superior performance compared to the reference treatment. This work highlights the great potential of this smart system as an attractive dressing for burns, which surpasses currently available treatments.
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Quemaduras , Sulfadiazina de Plata , Alginatos/farmacología , Antibacterianos/farmacología , Quemaduras/tratamiento farmacológico , Ciprofloxacina/farmacología , Fibroblastos , Humanos , Hidrogeles/farmacología , Integrina beta1 , Iones , Lidocaína , Polielectrolitos , Cicatrización de HeridasRESUMEN
PURPOSE: To compare four commercially available hydrogel formulations in the healing of partial thickness burns experimentally induced in rats. METHODS: Wistar rats were used, and after the burn wound induction they were divided into the following treatment groups: G1) NaCl 0.9%; G2) 1% silver sulfadiazine; G3) Debrigel™; G4) Safgel™; G5) Dersani™; G6) Solosite™. The animals were followed during seven, 14 and 30 days after the injury induction. Morphometric, macroscopic and microscopic evaluations were performed. RESULTS: The treatment with Dersani™ induced better results during the inflammatory and proliferative phases of the healing process (p<0.05). The animals treated with Safgel™ presented better scaring in the remodeling phase (p<0.05), and the treatment with Dersani™ and Solosite™ induced greater wound closure (p<0.05). CONCLUSIONS: The hydrogel-based dressings presented beneficial outcomes in the healing of burn wounds experimentally induced in rats due to their ability in maintain the humidity of the wound, in removing the exudate, in promoting cell migration and collagen production during the different phases of the healing process.
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Quemaduras , Hidrogeles , Animales , Vendajes , Quemaduras/tratamiento farmacológico , Ratas , Ratas Wistar , Sulfadiazina de Plata/farmacología , Sulfadiazina de Plata/uso terapéuticoRESUMEN
BACKGROUND: Nanocrystalline silver dressings can reduce the number of changes, facilitating burn wound management. However, the evidence regarding their efficacy and cost-consequences compared to well-established treatments, such as 1% silver sulfadiazine, is still scarce. OBJECTIVE: To determine the efficacy, safety, and costs of nanocrystalline silver dressings compared to 1% silver sulfadiazine dressings to treat adult patients with burns. STUDY DESIGN AND SETTING: Randomized, single-center, single-blind trial conducted at a referral hospital in São Paulo, Brazil. METHODS: 100 adult patients were randomized 1:1 to nanocrystalline silver (n = 50) or 1% silver sulfadiazine (n = 50). The primary outcome was the proportion of participants with complete re-epithelization at day 15 after randomization. Secondary outcomes included the number of dressing changes, direct medical costs (in international dollars, I$), pain intensity, the incidence of infections, number of patients undergoing surgery, and adverse events. RESULTS: On day 15, the proportion of patients who reached the primary outcome did not differ significantly between participants treated with nanocrystalline silver dressings (24 [48%]) and those treated with 1% silver sulfadiazine dressings (26 [52%]); risk difference of -4.0 percentage points (95% confidence interval [CI], -17 to 9; P = 0.56). The number of patients undergoing surgical intervention was similar between groups (6% vs. 6%), and no local or serious adverse events were reported. The mean (standard deviation, SD) number of dressing changes in the nanocrystalline silver group was 4.1 (2.3), and the corresponding estimate in the 1% silver sulfadiazine group was 9.6 (6.7); mean difference of -5.56 (95% CI), -7.57 to -3.55, P < 0.001). Treatment with nanocrystalline silver dressing incurred significant cost reductions in medical materials, human resources, and administrative labor. However, the mean total cost with nanocrystalline silver dressing was higher compared to 1% silver sulfadiazine dressings: I$496.37 (445.90) vs. I$274.73 (182.76); mean difference = 221.63 (95% CI, 89.04 to 354.23, P = 0.001). The main driver of higher mean total costs among nanocrystalline silver-treated participants was the purchase cost of the dressings, representing 79.3% of the total cost in the nanocrystalline silver group but only 15.2% in the 1% silver sulfadiazine group. CONCLUSION: We found no evidence of a difference between nanocrystalline silver and 1% silver sulfadiazine dressings regarding efficacy and safety outcomes. Nanocrystalline silver dressings were associated with an increase in the total costs, but they could result in important savings for an institution (less changes of dressings, reducing human resources burden), especially if acquisition costs can be decreased. Additional cost-effectiveness studies are warranted. TRIAL REGISTRATION NUMBER: NCT02108535.
Asunto(s)
Antiinfecciosos Locales , Quemaduras , Adulto , Antiinfecciosos Locales/uso terapéutico , Vendajes , Brasil , Quemaduras/complicaciones , Humanos , Pacientes Ambulatorios , Plata/uso terapéutico , Sulfadiazina de Plata/uso terapéutico , Método Simple CiegoRESUMEN
Purpose: To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings. Methods: Wistar rats were used, divided into six treatments: saline (NaCl 0.9%); silver sulfadiazine 1%; Silvercel; Mepilex Ag; Aquacel Ag and Acticoat. The animals were monitored daily and euthanized at 7, 14 and 30 days after injury induction (DAI). Results: At 7 DAI, necrosis/crust was greater in control, silver sulfadiazine and Mepilex Ag treatments, granulation tissue was induced by Aquacel Ag, polymorphonuclear infiltrate (PMN) infiltration was intensified by Mepilex Ag; mononuclear infiltrate (MN) infiltration and angiogenesis were increased by Silvercel. At 14 DAI, hemorrhage was decreased by Silvercel and Mepilex Ag, PMN infiltration increased by Acticoat. At 30 DAI, angiogenesis was greater in the Acticoat treatment and fibroblasts were increased by Acticoat and Mepilex Ag. Collagen was induced at 14 DAI by silver sulfadiazine and Aquacel Ag and, at 30 DAI, by silver sulfadiazine and Silvercel treatments. Conclusions: Silvercel and Acticoat presented better results than the other products. However, all the dressings were better than the control at some point during the process, and may contribute to the healing of partial thickness burns. Silvercel and Aquacel Ag treatments induced better cosmetic outcomes regarding wound closure and scarring.
Asunto(s)
Animales , Ratas , Sulfadiazina de Plata/uso terapéutico , Quemaduras Químicas/terapia , Compuestos de Plata/uso terapéutico , Vendas Hidrocoloidales/veterinaria , Ratas WistarRESUMEN
Abstract Hydrogels are interesting for use in the treatment of topical wounds due to their virtually zero toxicity, and capacity for extended release of pharmaceuticals. Silver sulfadiazine (SSDZ) is the drug of choice in the treatment of skin burns. The aim of the study was to determine cytotoxicity, antimicrobial activity and stability of a PVA hydrogel with integrated silver sulfadiazine. SSDZ-hydrogels were prepared using 10% (w/w) PVA (either 89% or 99% hydrolyzed) and 1% (w/w) silver sulfadiazine. Cellular viability was assessed via MTS assays, antimicrobial activity via disk-diffusion and accelerated stability tests were carried out with analysis at 0, 30, 60, 90 and 180 days of storage at 40 ± 2 °C and a relative humidity of 75 ± 5%. The parameters evaluated included organoleptic characteristics, moisture, swelling ability, mechanical strength, FTIR, XRD, TGA and DSC, and silver release patterns via XRD and potentiometry. Cell viability tests indicated some cytotoxicity, although within acceptable levels. After 90 days of storage, SSDZ hydrogel samples exhibited a brown coloration, probably due to the formation of Ag or Ag2O nanoparticles. The SSDZ-loaded hydrogels suffered visual and physical changes; however, these changes did not compromise its use as occlusive wound dressings or its antimicrobial properties.
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Sulfadiazina de Plata/farmacología , Preparaciones Farmacéuticas/análisis , Hidrogeles/análisis , Piel/lesiones , Heridas y Lesiones/clasificación , Espectroscopía Infrarroja por Transformada de Fourier , /clasificaciónRESUMEN
Resumen Objetivo: Mostrar la utilidad del apósito liofilizado de piel de cerdo comparado con el manejo conservador con sulfadiazina de plata en el proceso de cicatrización de la úlcera de pie diabético. Materiales y Método: Estudio cuasiexperimental en pacientes con diagnóstico de pie diabético, se establecieron 2 grupos de estudio utilizando una relación 2:1, el grupo de exposición (10 pacientes) tratado con apósito liofilizado de piel de cerdo y el grupo de control (5 pacientes) manejado con sulfadiazina de plata. La utilidad se midió con la cicatrización en semanas de tratamiento. El análisis estadístico incluyó prueba de t, prueba de z, regresión logística simple y cálculo de la probabilidad del evento. Resultados: El tiempo de cicatrización fue más corto en el grupo manejado con apósito liofilizado de piel de cerdo (10,20 semanas) que en el grupo con manejo a base de sulfadiazina de plata (13,8 semanas). A las 9 semanas de iniciado el tratamiento, la mitad de las pacientes con apósito de piel de cerdo ya habían cicatrizado comparado con la cicatrización en el grupo manejado con sulfadiazina de plata (20%). La probabilidad de cicatrización a las 11 semanas en paciente manejados con sulfadiazina de plata es 20% y con apósito liofilizado de piel de cerdo 80%. Conclusión: El apósito liofilizado de piel de cerdo tuvo mejores resultados en el estudio, comparado con el manejo estándar con sulfadiazina de plata. Es necesario realizar un estudio aleatorizado para determinar la efectividad de este material como herramienta terapéutica.
Aim: To demonstrate the usefulness of lyophilized pig skin dressings versus usual management with silver sulfadiazine in wound healing treatment for diabetic foot ulcers. Materials and Method: In this quasi-experimental study, we included patients diagnosed with diabetic foot. We established two groups with a distribution (2:1), the exposure group treated with lyophilized pig skin dressings (10 patients) and the control group (5 patients), the standard of care with silver sulfadiazine. Usefulness was measured with wound healing in treatment weeks. Statistical analysis included t-test, z-test, simple logistic regression, and calculation of probability of an event. Results: Wound healing time was shorter in the group treated with lyophilized pig skin dressing (10.20 weeks) than in the group treated with silver sulfadiazine (13.8 weeks). At 9 weeks after treatment started, 50% of patients treated with lyophilized pig skin dressings had complete wound healing compared with the patients in the group managed with silver sulfadiazine. (20%). The probability of wound healing been completed at 11 weeks in a patient managed with silver sulfadiazine is 20%, compared to lyophilized pig skin dressings is 80%. Conclusion: Lyophilized pig skin dressings had better outcomes than silver sulfadiazine in wound healing treatment for diabetic foot ulcers inside the study. Is mandatory develop another study with a randomized design to determinate the effectiveness as a therapeutic alternative.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Cicatrización de Heridas , Pie Diabético , Sulfadiazina de Plata/uso terapéutico , Apósitos Biológicos , DemografíaRESUMEN
Background: The bulb of Allium cepa Linnaeus (onion) is used in traditional medicine as an antidiabetic, antioxidant, antihypertensive, anti-inflammatory, and antihyperlipidemic, among others. The lack of information or little knowledge about the effects of Allium cepa L. on skin lesions, specifically burn wounds, arouses interest in studying its effects on these skin disorders. Objective: This study assessed the wound healing activity of Allium cepa L. on second-degree burns induced in Holtzman rats. Method: Thirty-two albino rats were randomly distributed into four groups of 8 rats each, including the Healthy group, the Control group, the Experimental group (Alliumcepa L.), and the Standard group (1% silver sulfadiazine). Burn wounds were induced, and topical treatments were performed daily for 21 days. The reduction of the burned body area (mm2) was determined during the experimental time. Albino rats were sacrificed with an excess of surgical anesthesia to obtain tissue samples for histopathological analysis. Results: Standard and experimental groups significantly reduced burned body area (p<0.01) compared to the control group. Histopathological studies showed hyperemic chorion in the Control group, fibroblasts, and collagen in the Standard group, and dermis composed of a reticular stratum of fibroblasts, collagen, and few blood vessels in the Experimental group. Conclusion: Allium cepa L. revealed wound-healing activity on burns induced in Holtzman rats and reduced the damage produced by burns
Antecedentes: El bulbo de Alliumcepa L. (cebolla) se utiliza en medicina tradicional como antidiabético, antioxidante, antihipertensivo, antiinflamatorio, anti hiperlipidémico entre otros. La falta de información o muy poco conocimiento acerca de los efectos de Allium. cepa L. en lesiones cutáneas, específicamente en las heridas por quemaduras, despierta el interés por estudiar sus efectos en estas afectaciones cutáneas. Objetivo: El objetivo de este estudio fue evaluar la actividad cicatrizante de Allium. cepa L. en quemaduras de segundo grado inducidas en ratas Holtzman. Método: Se utilizaron treinta y dos ratas albinas distribuidas al azar en cuatro grupos de ocho ratas cada uno, incluyendo el Grupo sano, el Grupo Control, el Grupo Experimental (Allium cepa L.) y el Grupo Estándar (Sulfadiazina de plata al 1%). Se indujo la herida por quemadura, y los tratamientos tópicos se realizaron diariamente durante 21 días. La reducción del área corporal quemada (mm2) se determinó durante el tiempo de experimentación, luego los animales fueron sacrificados con exceso de anestesia quirúrgica para obtener las muestras de tejidos para el estudio histopatológico. Resultados: Los grupos estándar y experimental mostraron reducción significativa en el área corporal quemada (p<0,01) comparadas al grupo control. El estudio histopatológico evidenció corion hiperémico en el grupo control; fibroblastos y colágeno en el grupo estándar y dermis integrada por un estrato reticular de fibroblastos, colágeno y pocos vasos sanguíneos en el grupo experimental. Conclusión: Alliumcepa L. reveló actividad cicatrizante en quemaduras inducidas en ratas Holtzman, y disminuyó el daño producido por las quemaduras
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Humanos , Fitoquímicos , Sulfadiazina de Plata , Quemaduras , Cebollas , HistologíaRESUMEN
(Bio)nanocomposites have been studied for biomedical applications, including the treatment of wounds. However, wound infection is one of the main problems of wound care management, and the use of wound dressings with antibacterial agents is essential. This work focused on developing and characterizing silver sulfadiazine-loaded halloysite/cassava starch-based (bio)nanocomposites potentially suitable as antimicrobial dressing. Silver sulfadiazine was complexed inside the halloysite nanotubes lumen, and the drug-loaded nanotubes were incorporated in thermoplastic starch dispersion, forming the (bio)nanocomposites. The silver sulfadiazine-loaded halloysite and the (bio)nanocomposite were characterized by zeta potential, scanning electron microscopy, X-ray diffraction, and infrared spectroscopy. The dressing properties of (bio)nanocomposites (water vapor permeability and mechanical stability) and their antimicrobial efficacy by Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were also evaluated. Physicochemical studies suggested the silver sulfadiazine-loaded halloysite complexation (zeta potential of -38.9 mV) and its interactions with the starch forming the nanocomposites. The silver sulfadiazine-loaded halloysite/starch-based (bio)nanocomposites possessed a homogeneous and organized structure. Also, they had mechanical properties to be used as a dressing (13.73 ± 3.09 MPa and 3.17 ± 1.28% of elongation at break), and its permeability (6.18 ± 0.43 (10-13) g.Pa-1.s-1.m-1) could be able to maintain the environmental moisture at the wound surface. Besides that, the (bio)nanocomposites acted against the studied bacteria, being a potential contact antimicrobial and biodegradable wound dressing. Finally, the developed (bio)nanocomposites are semi-occlusive and good candidates for dry wounds to be widely in vitro and in vivo tested as controlled silver sulfadiazine delivery dressing.
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Antibacterianos/química , Antibacterianos/farmacología , Vendajes , Nanocompuestos/química , Sulfadiazina de Plata/química , Materiales Biocompatibles/química , Arcilla/química , Escherichia coli/efectos de los fármacos , Manihot/química , Permeabilidad , Pseudomonas aeruginosa/efectos de los fármacos , Sulfadiazina de Plata/farmacología , Espectroscopía Infrarroja por Transformada de Fourier , Staphylococcus aureus/efectos de los fármacos , Almidón/química , Vapor , Difracción de Rayos XRESUMEN
In the surgical suture, the implanted thread can be a source of microbial contamination. Implanted materials are frequently described as being substrates prone for biofilm development provoking surgical site infections. Treatment of postsurgical wounds with different topical antimicrobial agents is a current practice applied to every patient. However, to date, there is little evidence on the efficacy of different antiseptic treatments on suture materials in preventing environmental or skin bacterial adhesion and further infection. Here, the authors compared the ability of an aerosol formulation of silver sulfadiazine, vitamin A, and lidocaine (AF-SSD) and of two of the most frequently used topical treatments, povidone-iodine and ethanol, in eradicating or controlling the microbial contamination of suture threads in patients who have undergone clean surgeries. Postsurgical suture threads treated with AF-SSD showed a significantly reduced proportion of contaminated samples containing viable microbial cells compared with those treated with povidone-iodine or ethanol. Furthermore, those samples that were positive for bacterial growth showed a lesser number of viable cells in AF-SSD-treated sutures than those treated with povidone-iodine or ethanol. Confocal laser scanning microscopy showed that AF-SSD-treated postsurgical sutures presented significantly less attached microbial cells than povidone-iodine and ethanol, with scarce observable microbial cells on the surface of the suture. Taken together, the results suggest that treatment with AF-SSD is more effective than the other two antiseptics, and there is a potential for improvement in reducing the microbial burden of implanted materials such as the suture thread.
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Antiinfecciosos Locales/uso terapéutico , Quemaduras/terapia , Etanol/uso terapéutico , Povidona Yodada/uso terapéutico , Sulfadiazina de Plata/uso terapéutico , Infección de la Herida Quirúrgica/prevención & control , Administración Tópica , Aerosoles , Quemaduras/tratamiento farmacológico , Estudios de Seguimiento , Humanos , Suturas , Cicatrización de HeridasRESUMEN
The management of tar burns presents a wide range of possible approaches, and several strategies can be used to reduce the damage regarding the removal of tar adhered to the patient's skin. Tar residues should preferably be emulsified with solvent solutions. Due to the low incidence of tar burns, it has not yet been possible to select the appropriate agent for the removal of the adhered tar. In this article, we reported a case of a 47-year-old man with a tar burn in his forehead region and his both upper limbs treated with two different approaches and the outcomes. In the right upper limb, the removal of tar with oil-based on essential fatty acids was attempted at the time of hospital admission, whereas in the left upper limb, he was treated with 1% silver sulfadiazine cream, sterile gauze, and bandage. On the right upper limb, the treatment was eventually performed with debridement and split-thickness skin grafting. On the left upper limb, there was complete re-epithelialization of the burns. The more conservative approach of keeping a dressing with 1% silver sulfadiazine on the tar itself, followed by removing the material in the dressing changes was considered better than the immediate removal of tar with an oily solution, especially about pain. Our impression was that the application of 1% silver sulfadiazine cream at the time of the admission, as well as in the following days, may be beneficial for the removal of the tar in close contact with the skin. Possibly, this approach leads to less trauma to the skin and, eventually, simplifies the treatment of burns by hot tar.
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Antiinfecciosos Locales/administración & dosificación , Vendajes , Quemaduras Químicas/terapia , Traumatismos Ocupacionales/terapia , Sulfadiazina de Plata/administración & dosificación , Breas , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Dimensión del DolorRESUMEN
OBJETIVO: Identificar quais os curativos e coberturas mais utilizados no tratamento de feridas por queimaduras no Brasil. MÉTODO: Trata-se de uma revisão narrativa, com artigos publicados no período de 2011 a 2020. A busca foi realizada na Biblioteca Virtual em Saúde a partir dos descritores: curativo, cobertura, queimadura e enfermagem, no mês de maio de 2021. RESULTADOS: Foram selecionados oito estudos para análise e, a partir da leitura desses artigos, as coberturas citadas foram: sulfadiazina de prata, ácido hialurônico e película de biocelulose, assim como gaze não aderente, hidrogel e hidrofibra de carboximetilcelulose sódica. CONSIDERAÇÕES FINAIS: Conhecer as coberturas utilizadas no tratamento de queimadura permite melhor e mais rápido resultado para o paciente, diminui os custos da instituição e favorece a equipe assistencial, que não sofre desgaste emocional, pois observa resultados positivos no tratamento das lesões.
OBJECTIVE: To identify which dressings are most used in the treatment of burn wounds in Brazil. METHODS: This is a narrative review, with articles published from 2011 to 2020. The search was carried out in the Virtual Health Library using the descriptors: dressing, coverage, burns, and nursing, in May 2021. RESULTS: Eight studies were selected for analysis, and from the reading of these articles, the coatings cited were: silver sulfadiazine, hyaluronic acid, and biocellulose film, as well as non-adherent gauze, hydrogel, and sodium carboxymethylcellulose hydrofiber. FINAL CONSIDERATIONS: Knowing the dressings used in the treatment of burns allows for better and faster results for the patient, reduces the institution's costs, and favors the care team, which does not suffer emotional distress, as it observes positive results in the treatment of injuries.
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Humanos , Quemaduras/terapia , Atención al Paciente/métodos , Sulfadiazina de Plata/uso terapéutico , Vendajes/provisión & distribución , Ácido Hialurónico/uso terapéuticoRESUMEN
In the present study, supramolecular polyelectrolyte complexes (SPEC) based on a cyclodextrin-grafted chitosan derivative and carrageenan were prepared and evaluated for controlled drug release. Samples were characterized by FTIR, SEM, and ζ-potential measurements, which confirmed the formation of the polymeric complex. The phenolphthalein test confirmed the presence and availability of inclusion sites from the attached ßCD. Silver sulfadiazine was used as the model drug and the association with the SPEC was studied by FTIR and computational molecular modeling, using a semi-empirical method. DRS and TEM analyses have shown that Ag+ ions from the drug were reduced to form metallic silver nanostructures. In vitro tests have shown a clear bacterial activity toward Gram-positive bacteria Staphylococcus aureus and Enterococcus durans/hirae and Gram-negative bacteria Klebsiella pneumoniae and Escherichia coli. Finally, this work shows that ßCD-chitosan/carrageenan supramolecular polyelectrolyte complexes hold an expressive potential to be applied as a polymer-based system for controlled drug release.
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Antibacterianos/química , Antibacterianos/farmacología , Carragenina/química , Quitosano/química , Ciclodextrinas/química , Liberación de Fármacos/efectos de los fármacos , Polielectrolitos/química , Polielectrolitos/farmacología , Biología Computacional/métodos , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Iones/química , Pruebas de Sensibilidad Microbiana , Nanoestructuras/química , Plata/química , Sulfadiazina de Plata/química , Sulfadiazina de Plata/farmacologíaRESUMEN
This study aims to evaluate the efficacy of Nile tilapia skin as a xenograft for the treatment of partial-thickness burn wounds in children. This is an open-label, monocentric, randomized phase II pilot study conducted in Fortaleza, Brazil. The study population consisted of 30 children between the ages of 2 and 12 years with superficial "partial-thickness" burns admitted less than 72 hours from the thermal injury. In the test group, the tilapia skin was applied. In the control group, a thin layer of silver sulfadiazine cream 1% was applied. Tilapia skin showed good adherence to the wound bed, reducing the number of dressing changes required, the amount of anesthetics used, and providing benefits for the patients and also for healthcare professionals, by reducing the overall work load. The number of days to complete burn wound healing, the total amount of analgesics required throughout the treatment, burn improvement on the day of dressing removal, and pain throughout the treatment were similar to the conventional treatment with silver sulfadiazine. Thus, tilapia skin can be considered an effective and low-cost extra resource in the therapeutic arsenal of pediatric superficial partial thickness burns.
Asunto(s)
Quemaduras/cirugía , Trasplante de Piel/métodos , Tilapia , Animales , Brasil , Niño , Preescolar , Femenino , Xenoinjertos , Humanos , Lactante , Masculino , Proyectos Piloto , Sulfadiazina de Plata/uso terapéutico , Cicatrización de HeridasRESUMEN
BACKGROUND: Silver sulfadiazine (SSD) has been widely used in burned patients for the prevention of local infections. To be biologically active and exert antimicrobial properties, silver needs to be present in the form of silver ions (Ag1+) that bind to negatively charged proteins, namely, the RNA and DNA in microorganisms. However, previous published studies conducted with SSD in the 1990s reported a high level of silver absorption through damaged skin and noted the potential cytotoxicity of Ag1+ to human cells. SSD toxicity, however, had been described in cell cultures using arbitrary silver concentrations. In the present study, we determined the serum silver levels in burned patients treated with SSD and, taking into account the molar Ag1+ concentrations found in these patients, we evaluated the Ag1+ toxicity effects on inflammatory cells (ROS and cytokine production) in vitro. METHODS: Twenty patients with an average burned body surface area of 27.68% were included in this study. RESULTS: Patients' Ag1+ serum levels reached up to 558 times those of the unexposed controls. Ag1+ was then added to inflammatory cells in vitro at levels up to 2000 times the level of the control, and there was no effect on the viability of the cells nor on the rate of apoptosis. We observed a decrease in reactive oxygen species production by mononuclear (MN) and polymorphonuclear (PMN) cells, as well as a substantial decrease in cytokines IL-1ß, IL-6, IL-8, IL-10, and TNF-α production by leukocytes (MN and PNM). CONCLUSION: These findings suggest that Ag1+ may contribute to negative outcomes after burns, decreasing the primary defense mechanism (respiratory burst) and altering cytokine production.
Asunto(s)
Antiinfecciosos Locales/toxicidad , Antiinfecciosos Locales/uso terapéutico , Quemaduras/tratamiento farmacológico , Leucocitos Mononucleares/efectos de los fármacos , Neutrófilos/efectos de los fármacos , Nitrato de Plata/toxicidad , Sulfadiazina de Plata/uso terapéutico , Plata/sangre , Adulto , Apoptosis/efectos de los fármacos , Superficie Corporal , Supervivencia Celular/efectos de los fármacos , Femenino , Humanos , Técnicas In Vitro , Interleucina-10/metabolismo , Interleucina-1beta/efectos de los fármacos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Interleucina-8/efectos de los fármacos , Interleucina-8/metabolismo , Leucocitos Mononucleares/metabolismo , Masculino , Neutrófilos/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Factor de Necrosis Tumoral alfa/efectos de los fármacos , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
OBJETIVO: Avaliar a eficácia da alta frequência na cicatrização de feridas por queimadura durante internação hospitalar. MÉTODO: Trata-se de um estudo de caso, realizado com uma voluntária do sexo feminino, 19 anos, em um hospital de pronto-socorro. Foram aplicados a alta frequência e curativos convencionais, com a amostra única sendo dividida em área de intervenção e área controle. Foram avaliados dados clínicos e sociodemográficos, registros fotográficos pré e pós as intervenções, dimensão da área da ferida por meio de planimetria digitalizada, aspecto da cicatriz através da Escala Vancouver e a qualidade de vida por meio do questionário Burn Specific Health Scale. RESULTADOS: A área da ferida teve redução de 54% na área de intervenção e 26% na área controle. Aspectos como vascularização e flexibilidade também apresentaram discreta melhora. O questionário de qualidade de vida reduziu dois pontos, relacionados à melhora da sensibilidade da pele e aos cuidados com a queimadura. CONCLUSÃO: A utilização de alta frequência combinada com uso de curativos durante a internação hospitalar mostrou resultados favoráveis em comparação a apenas o uso de curativos na cicatrização de feridas. Contudo, mais estudos são necessários.
OBJECTIVE: To evaluate the effectiveness of the high frequency in the healing of burn wounds during hospitalization. METHODS: This is a case study, conducted with a 19-year-old female volunteer, in an emergency room. The high frequency and conventional dressings were applied, with the single sample being divided into the intervention area and the control area. Clinical and sociodemographic data, photographic records before and after the interventions, dimension of the wound area through digitalized planimetry, the aspect of the scar through the Vancouver Scale and quality of life through the Burn Specific Health Scale questionnaire were evaluated. RESULTS: The wound area decreased 54% in the intervention area and 26% in the control area. Aspects such as vascularity and flexibility also showed a slight improvement. The quality of life questionnaire reduced two points, related to the improvement of skin sensitivity and care for burns. CONCLUSION: The use of the high frequency combined with the use of dressings during hospitalization showed favorable results compared to only the use of dressings in wound healing. However, more studies are needed.
Asunto(s)
Humanos , Femenino , Adulto , Cicatrización de Heridas , Quemaduras/terapia , Terapia por Estimulación Eléctrica/instrumentación , Sulfadiazina de Plata/administración & dosificación , Vendajes/provisión & distribuciónRESUMEN
OBJECTIVE: to identify, through an integrative review, national studies published over the last ten years highlighting products and therapies used in burns. METHODS: integrative research with studies published in the last ten years. Including clinical studies describing the use of the already established or innovative therapies in burns and the results obtained, published in national journals in the last ten years. Excluding articles published before 2007 and those that did not present results regarding the use of products in burns. RESULTS: ten articles that met the inclusion criteria were selected. Collagenase, 1% silver sulfadiazine, and porous cellulose membrane were some of the therapies cited. CONCLUSION: the casuistry was low; however, the good results obtained with porous cellulose membrane and silver nanocrystalline dressing are highlighted, since they were used in a larger number of patients in the studies evaluated.