RESUMO
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.
Assuntos
Sulfadiazina de Prata/farmacologia , Preparações Farmacêuticas/análise , Hidrogéis/análise , Pele/lesões , Ferimentos e Lesões/classificação , Espectroscopia de Infravermelho com Transformada de Fourier , /classificaçãoRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cicatrização , Pé Diabético , Sulfadiazina de Prata/uso terapêutico , Curativos Biológicos , DemografiaRESUMO
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
Assuntos
Humanos , Compostos Fitoquímicos , Sulfadiazina de Prata , Queimaduras , Cebolas , HistologiaRESUMO
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.
Assuntos
Antibacterianos/química , Antibacterianos/farmacologia , Carragenina/química , Quitosana/química , Ciclodextrinas/química , Liberação Controlada de Fármacos/efeitos dos fármacos , Polieletrólitos/química , Polieletrólitos/farmacologia , Biologia Computacional/métodos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Íons/química , Testes de Sensibilidade Microbiana , Nanoestruturas/química , Prata/química , Sulfadiazina de Prata/química , Sulfadiazina de Prata/farmacologiaRESUMO
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.
Assuntos
Anti-Infecciosos Locais/toxicidade , Anti-Infecciosos Locais/uso terapêutico , Queimaduras/tratamento farmacológico , Leucócitos Mononucleares/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Nitrato de Prata/toxicidade , Sulfadiazina de Prata/uso terapêutico , Prata/sangue , Adulto , Apoptose/efeitos dos fármacos , Superfície Corporal , Sobrevivência Celular/efeitos dos fármacos , Feminino , Humanos , Técnicas In Vitro , Interleucina-10/metabolismo , Interleucina-1beta/efeitos dos fármacos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Interleucina-8/efeitos dos fármacos , Interleucina-8/metabolismo , Leucócitos Mononucleares/metabolismo , Masculino , Neutrófilos/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Biopolymeric films with silver sulfadiazine (AgSD) are proposed as an alternative to the occlusive AgSD-containing creams and gauzes, which are commonly used in the treatment of conventional burns. While the recognized cytotoxicity of AgSD has been reported to compromise its use as an antimicrobial drug in pharmaceuticals, this limitation can be overcome by developing sustained-release formulations. Microporous materials as zeolites can be used as drug delivery systems for sustained release of AgSD. The purpose of this work was the development and characterization of chitosan/zeolite composite films to be used as wound dressings. Zeolite was impregnated with AgSD before the production of the composite films. The physicochemical properties of zeolites and the films were evaluated, as well as the antimicrobial activity of the polymeric films and the cytotoxicity of the films in fibroblasts Balb 3T3/c. Impregnated zeolite exhibited changes in FTIR spectra and XRD diffraction patterns, in comparison to non-impregnated composites, which corroborate the results obtained with EDX-SEM. The pure chitosan film was compact and without noticeable defects and macropores, while the film with zeolite was opaquer, more rigid, and efficient against Candida albicans and some gram-negative bacteria. The safety evaluation showed that although the AgSD films present cytotoxicity, they could be used in a concentration-dependent fashion.
RESUMO
Hybrid delivery systems can release multiple drugs with different profiles and have several applications, including skin dressing. In this work, the co-solvent technique was used for the preparation of nanometric vesicles based on poly(styrene-b-ethylene oxide) block copolymer (BCPVs) containing adapalene (AD). The BCPVs were incorporated into collagen and gelatin matrices together with free AD and silver sulfadiazine (SSD). The AD content of BCPVs and their release capacity were analyzed by using ultraviolet-visible spectroscopy (UV-Vis). The gelatin and collagen matrices were evaluated for their ability to release AD and SSD through an in vitro release study. The obtained results confirmed that the production of empty and AD-loaded BCPVs was viable. The degree of AD encapsulation in BCPVs was 9.0% and the in vitro test revealed a constant, slow, and prolonged release of AD content from AD-loaded BCPVs. The combination of free and encapsulated multiple drugs in hybrid delivery systems based on gelatin and collagen matrices was shown to act as a skin dressing that combined the progressive release of large amounts of drugs within the first hours of use (to restrict infection) with a more prolonged and slow release of AD to enhance skin healing.
Assuntos
Colágeno/química , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Gelatina/química , Polietilenoglicóis/química , Poliestirenos/química , Adapaleno/química , Sulfadiazina de Prata/química , Propriedades de SuperfícieRESUMO
Abstract This study aims to evaluate tissue healing efficacy in burn patients treated with 1% silver sulfadiazine versus other treatments. This is a systematic literature review and meta-analysis of randomized clinical trials performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) and PICO strategy, registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42017081057. The review found 71 studies in MEDLINE/Pubmed, 1 in Clinical Trials, 19 in the Cochrane Library, and 4 in LILACS in five manual searches. Of these, 81 studies were pre-selected. After independent analysis by two reviewers, only 11 studies met the inclusion criteria for the review. All studies (n = 11) using alternative treatments to silver sulfadiazine were shown to be superior in the mean time for complete wound healing, with statistically significant differences between experimental and control groups (p <0.00001); mean difference (- 4.26), 95% CI [- 5.96, - 2.56].
Assuntos
Humanos , Sulfadiazina de Prata/uso terapêutico , Cicatrização/efeitos dos fármacos , Queimaduras/tratamento farmacológico , Anti-Infecciosos Locais/uso terapêutico , Sulfadiazina de Prata/farmacologia , Fatores de Tempo , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Hospitalização , Anti-Infecciosos Locais/farmacologiaRESUMO
Loxoscelismo es el cuadro clínico originado por la mordedura de araña del género Loxosceles. Es considerado un accidente que ocurre con mayor frecuencia en las noches, debido al hábito nocturno de la araña y buena adaptación a los ambientes domésticos, preferentemente en espacios oscuros y secos. Clínicamente presenta dos escenarios, cutáneo (83,3 %) y visceral o sistémico (16 %), con una variación del cuadro cutáneo denominado loxoscelismo predominantemente edematoso. El objetivo es informar un caso inusual de loxoscelismo escrotal. El diagnóstico se realizó mediante las características clínicas y epidemiológicas del accidente. En conclusión, el loxoscelismo escrotal es una entidad muy infrecuente, el manejo del paciente influye mucho en su evolución y progresión; el tratamiento exhaustivo con sulfadiazina 2 veces al día y antibióticos intravenosos, muestra resultados muy favorables.
Loxoscelism is a condition produced by the bite of spiders from the genus Loxosceles. It is considered to be an accident that occurs mostly in the night, due to the spider's nocturnal habits and good adaptation to domestic environments, preferably dark, dry spaces. It presents in two clinical scenarios: cutaneous (83.3 %) and visceral or systemic (16 %), with a variation in the cutaneous manifestation known as predominantly edematous loxoscelism. The objective of the study was to report an unusual case of scrotal loxoscelism. Diagnosis was based on the clinical and epidemiological characteristics of the accident. It is concluded that scrotal loxoscelism is a very infrequent condition. Management of the patient greatly influences its evolution and progress. Exhaustive treatment with sulfadiazine twice daily and intravenous antibiotics yields very favorable results.
RESUMO
Introducción: Existen varias curaciones para quemaduras. La sulfadiazina de plata se ha usado por años pero las membranas microporosas son cada vez más preferidas. Objetivos: Comparar la eficiencia de las membrana microporosa (Telfa Clear®) versus sulfadiazina de plata (Platsul®) en menores de 15 años hospitalizados por quemadura. Pacientes y Métodos: Estudio de cohorte retrospectivo de 87 pacientes, dividido en 2 grupos comparables en extensión y profundidad de la quemadura, edad y sexo. Durante enero a diciembre 2007 se curaron 52 pacientes con Platsul® y desde enero a octubre 2008 se curaron 35 con Telfa Clear®. Se evalúa tiempos y extensión de reepitelización, porcentaje de injertos, costos, días de hospitalización, número de curaciones, complicaciones, almacenamiento-estabilidad y costos. Estadística no paramétrica para el análisis univariado y regresión logística multivariado en Stata 11.2. Resultados: Los pacientes curados con Platsul® se injertaron más tardíamente y presentan más curaciones. Platsul® es peor evaluado por su almacenamiento-estabilidad y mayores costos. No hay diferencia en la incidencia de infección. Conclusiones: Ambas Técnicas son eficientes en permitir reepitelización, pero Platsul® puede demorar el injerto. La Telfa Clear® es mejor evaluado por el equipo de salud en cuanto a almacenamiento y estabilidad. El menor costo de Telfa Clear® es una ventaja.
Introduction: There are several dressings for burns. Silver sulfadiazine has been used for years but microporous membranes are increasingly preferred. Objectives: To compare the efficiency of microporous membrane (Telfa Clear®) versus silver sulfadiazine (Platsul®) in children younger than 15 years old hospitalized for burns. Patients and Methodology: Retrospective cohort study of 87 patients, divided into 2 comparable groups in extent and depth of the burn, age and sex. During January to December 2007, in 52 patients Platsul® were use and in 35 patients Telfa Clear® were use from January to October 2008. The time and extent of re-epithelialization, percentage of grafts, costs, length of stay, number of dressing change, complications, storage-stability and costs are evaluated. Non-parametric statistics were used for univariate analysis and logistic regression for multivariate analysis en Stata 11.2. Results: Platsul® was associate to a later graft and had a greater number of dressing changes. Platsul® is worst rated for its storage-stability and higher costs. No difference in infection rate was observed. Conclusions: Both techniques are efficient in allowing re-epithelialization, but burns treated with Platsul® were grafted later than when Telfa Clear® was used. Telfa Clear® is best evaluated by the health team in terms of storage and stability. The cost of Telfa Clear® is presented as an advantage.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Sulfadiazina de Prata/uso terapêutico , Bandagens , Queimaduras/terapia , Anti-Infecciosos Locais/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , ReepitelizaçãoRESUMO
As queimaduras ainda são r esponsáveis por grande parte dos ferimentos e óbitos decorrentes de causas externas no Brasil, bem como por grande número de afastamento do trabalho e sequelas funcionais e estéticas, principalmente na população masculina. A avaliação das queimaduras deve levar em consideração o grau de profundidade, localização, acometimento de vias aéreas e agente causal. Nos casos com indicação de tratamento ambulatorial, o antimicrobiano tópico de escolha ainda é a sulfadiazina de prata a 1%, após lavagem adequada das lesões, além da profilaxia do tétano. A prevenção de cicatrizes hipertróficas e queloides é muito importante para evitar limitações de movimento e de convívio social.
Burns are still the cause of a great portion of injuries and deaths triggered by external factors in Brazil. Also, it is intensely linked to absenteeism, and functional and aesthetic sequelae, especially in the male population. The assessment of burns should take into account their depth and location, involvement of the upper airways and causative agent. In cases where the treatment is carried out in an outpatient setting, after adequate washing of the lesions, 1% silver sulfadiazine cream is still the topical antimicrobial of choice, in addition to tetanus prophylaxis. Aimed at avoiding possible limitations of motion and social interaction, the prevention of hypertrophic scars and keloids is very important.
RESUMO
OBJETIVO: Este artigo tem por objetivo relatar as possíveis vantagens de curativos na forma de lâminas impregnadas com prata iônica (Atrauman®, Mepilex border Ag®, Mepilex-Ag® e Silvercel não aderente®) como agentes tópicos substitutos do creme de sulfadiazina de prata 1% nas queimaduras profundas. RELATO DOS CASOS: Foram tratados 31 pacientes. O Atrauman-Ag® foi empregado em 15 pacientes, o Mepilex border Ag® em três, Mepilex-Ag® em quatro e o Silvercel não aderente® em nove pacientes. Do total, relatamos a utilização destes novos curativos em dois pacientes do estudo com diagnóstico inicial de queimadura profunda. Em nenhum caso foram observados sinais de infecção nas feridas, apesar das trocas de curativos terem sido realizadas entre 4 a 7 dias, mesmo nas queimaduras de espessura total. O conforto propiciado por estes curativos foi evidente, minimizando o estresse e dor e as feridas de espessura parcial se apresentaram com sinais evidentes de rápida epitelização. CONCLUSÃO: Neste estudo preliminar, notamos que todos pacientes se beneficiaram de modo significativo do uso de curativos modernos com lâminas impregnadas por prata iônica quando comparados ao curativo convencional de sulfadiazina. Além da proteção contra infecção, mesmo nas queimaduras de espessura total, eles oferecem a enorme vantagem de as trocas serem espaçadas entre 4 a 7 dias, quando comparados à sulfadiazina, que exige a troca diária dos curativos, minimizando dor e desconforto aos pacientes e também o estresse da equipe de saúde envolvida nos Centros de Tratamento de Queimados.(AU)
OBJECTIVES: This article aims to evaluate the efficacy, and possible advantages of dressings in the form of ionic silver impregnated sheets (Atrauman Ag®, Mepilex Border Ag®, Mepilex - Ag® and Silvercel non - adherent®) as a local substitute agents for the cream of silver sulfadiazine-1% on deep burns. CASE REPORTS: 31 patients were treated. Atrauman-Ag® was used in 15 patients, Mepilex Border Ag® in three, Mepilex-Ag® in four and Silvercel non-adherent® in nine patients. Of the total, we report the use of these new dressings in two patients. In no case were signs of wound infection, even though dressing changes were performed between 4 and 7 days, also in total thickness burns. The comfort provided by these dressings was evident, minimizing stress and pain and partial thickness wounds presented with clear signs of rapid epithelization. CONCLUSION: In this preliminary study, we noticed that all patients benefited significantly from the use of new dressings with ionic silver impregnated sheets when compared to the conventional dressing of sulfadiazine cream. In addition to protection against infection, even in full-thickness burns, they offer the significant advantage that the changes of dressings are spaced between 4 and 7 days. Compared to sulfadiazine, which requires the daily exchange of dressings, they minimize pain and discomfort to patients, and also the stress to the health team involved in the treatment of the Burn Treatment Centers.(AU)
Objetivos: Este artículo tiene como objetivo evaluar la eficacia preliminar y los beneficios potenciales de la curación en forma de láminas impregnadas con plata iónica (Atrauman®, Mepilex Border Ag®, Mepilex-Ag® y Silvercel no aderente®) como sustitutos de crema de sulfadiazina de plata al 1% en quemaduras profundas. Casos Clínicos: Se han tratado 31 pacientes. El Atrauman-Ag® se utilizó en 15 pacientes, Mepilex Border Ag® en tres, Mepilex Ag® en cuatro y Silvercel no adherente® en nueve pacientes. Del total, se presenta la utilización de estos nuevos apósitos en dos pacientes. En ningún caso se observaron signos de infección en las heridas, a pesar de los cambios de apósito se llevaron a cabo entre los 4 y 7 días, incluso en quemaduras de espesor total. La comodidad ofrecida por éstos curación era evidente, lo que minimiza el estrés y el dolor y las heridas de espesor parcial se presentan con signos claros de una rápida epitelización. Conclusión: En este estudio preliminar, se observó que todos los pacientes se beneficiaron significativamente del uso de apósitos impregnados con plata iónica en comparación con sulfadiazina. Además de la protección contra la infección, incluso en quemaduras de espesor total, ofrecen la gran ventaja de las cambios están separadas de 4 a 7 días en comparación con sulfadiazina, que requiere el cambio diario de vendajes, minimizando dolor y malestar a los pacientes, e también el estrés del personal de salud de los centros de tratamiento de Queimados.(AU)
Assuntos
Humanos , Prata/uso terapêutico , Cicatrização/efeitos dos fármacos , Queimaduras/tratamento farmacológico , Curativos Oclusivos , Sulfadiazina de Prata/uso terapêutico , Unidades de Queimados , Administração TópicaRESUMO
Las quemaduras se producen cuando el tejido vivo está en contacto durante un largo periodo con un objeto o sustancia caliente. Se describen varias áreas de participación, que varían de acuerdo con el potencial de reversión de la lesión, como la zona de coagulación, estasis e hiperemia. Con respecto a la profundidad de la lesión, pueden ser clasificadas de acuerdo a el espesor, en superficial, superficial parcial, parcial profunda y completa. La extensión de piel afectada se calcula en base a la "regla de los nueves", que establece que cada parte del cuerpo corresponde a un múltiplo de 9% de la superficie corporal total. Aunque es poco frecuente en los pacientes veterinarios, quemaduras graves pueden llevar a un shock al disminuir el flujo de sangre periférica. Se debe realizar como terapia tópica inicial la tricotomia amplia seguida de la aplicación de solución salina fria, lavar con solución isotónica estéril, debridamiento, aplicación de ungüento antimicrobiano como sulfadiazina de plata y cubrir con vendas húmedas no adherentes. El debridamiento del tejido desvitalizado debe realizarse lo antes posible y, preferentemente, de forma agresiva. En la imposibilidad de realización de cirugía se puede utilizar los agentes conservadores enzimáticos de debridamiento, la inmersión en el agua y la aplicación de vendajes húmedos-húmedas. Después de la formación del lecho vascular sin tejido necrótico o infectado, quemaduras extensas se pueden cerrar mediante colgajos, injertos de piel, la técnica de avance de piel, o tratadas como herida abierta hasta que sea posible el tratamiento quirúrgico. Pueden ocurrir complicaciones como infección, cicatrización excesiva y la contractura de la herida, sobre todo cuando no hay un tratamiento temprano. [...](AU)
Burns occur when living tissues are in contact for a long period with a heated object or substance. Various zones of involvement are described, ranging as the reversal potential of the lesion, they are the zone of coagulation, stasis and hyperemia. Regarding the depth of the lesion, they can be graded according to the thikness, as superficial, superficial partialthickness, deep partial-thickness and full-thickness. The extent of affected skin can be calculated based on the Rule of Nines, which states that each part of the body corresponds to a multiple of 9% of the total body surface. Although rare in veterinary patients, severe burns can lead to shock by decreasing of peripheral blood flow. Wide hair removal, followed by application of cold saline solution, lavage with sterile isotonic solution, debridement, application of antimicrobial ointment as silver sulfadiazine and cover with moist nonadherent dress must be performed as the initial topical therapy. The debridement of devitalized tissue should be performed as early as possible and preferably aggressively. The impossibility to performing the surgery, conservative debridement can be done with enzymatic agents, immersion in water and the application of wet-wet dress. After formation of a vascular bed free of necrotic and infected tissue, extensive burns can be closed by flaps, skin grafting techniques, skin advance techniques or treated as an open wound until surgical treatment can be possible. Complications as infection, excessive scarring and wound contracture can occur, especially when there is not early treatment. The final cosmetic result is usually satisfactory when there is surgical intervention and complete hair covering. Although rare in veterinary medicine, severe burns are challenging and unlike traumatic wounds, presents different features and therapeutic. The abundant literature nowadays is mostly human and more veterinary studies are necessary in this area.(AU)
Queimaduras ocorrem quando tecido vivo entra em contato por um longo período com um objeto ou substância aquecida. São descritas diversas zonas de acometimento, variando conforme o potencial de reversão da lesão, sendo elas a zona de coagulação, estase e hiperemia. Em relação à profundidade da lesão, estas podem ser graduadas conforme a espessura em superficial, parcial superficial, parcial profunda e total. A extensão de pele acometida pode ser calculada com base na regra dos nove, que determina que cada parte do corpo corresponde a um múltiplo de 9% do total da superfície corpórea. Apesar de raro nos pacientes veterinários, queimaduras graves podem levar ao choque por diminuição do fluxo sanguíneo periférico. Deve-se realizar como terapia tópica inicial a tricotomia ampla seguida da aplicação de solução salina gelada, lavagem com solução isotônica estéril, debridamento, aplicação de pomada antimicrobiana como sulfadiazina de prata e a cobertura com bandagens úmidas não aderentes. O debridamento de tecido desvitalizado deve ser realizado o mais precocemente possível e preferencialmente de forma agressiva. Na impossibilidade de realização da intervenção cirúrgica, pode-se realizar o debridamento conservativo com agentes enzimáticos, imersão em água e a aplicação de bandagens úmida-úmida. Após a formação do leito vascular livre de tecido necrótico e infectado, as queimaduras extensas podem ser fechadas por meio de retalhos, enxertos cutâneos, técnicas de avanço de pele ou ainda tratadas como ferida aberta até que o tratamento cirúrgico seja possível. Como complicações, podem ocorrer infecção, cicatrização excessiva e contratura da ferida, especialmente quando não há tratamento precoce. O resultado cosmético final normalmente é satisfatório quando há intervenção cirúrgica e recobrimento piloso completo. [...](AU)
Assuntos
Animais , Gatos , Cães , Queimaduras/terapia , Queimaduras/veterinária , Sulfadiazina de Prata/uso terapêutico , Desbridamento , Ferimentos e Lesões/veterináriaRESUMO
Development and optimization of a hydrogel with impregnated silver sulfadiazine was pursued, for antimicrobial topical applications. The selected hydrogel exhibited a homogeneous appearance, with whitish colloration and devoid of any fractures or cracks. The content in impregnated silver sulfadiazine was within established limits (1%, w/w) with a standard deviation of up to 1.28%. The hydrogel presented a good characteristic in relation to release of the active antimicrobial principle, verified through swelling tests and antimicrobial activity. The swelling tests indicated a higher increase in weight during the first 6 h of contact with a moist environment, with a maximum value of 266.00 ± 0.81, and with maintenance of the original shape of the hydrogel. The impregnated silver sulfadiazine presented antimicrobial activity, as expected, indicating a prolonged release of the drug. The infrared spectra of the hydrogel with impregnated silver sulfadiazine indicated that the drug did not engage in any bonds with the polymeric matrix, which otherwise could have reduced its antimicrobial activity. The mechanical resistance tests produced good results, indicating that the hydrogels may be utilized in different locations of the human body with skin lesions.
Assuntos
Antibacterianos/química , Hidrogel de Polietilenoglicol-Dimetacrilato/química , Sulfadiazina de Prata/química , Prata/química , Antibacterianos/farmacologia , Hidrogel de Polietilenoglicol-Dimetacrilato/farmacologia , Prata/farmacologia , Sulfadiazina de Prata/farmacologia , Staphylococcus aureus/efeitos dos fármacosRESUMO
Las quemaduras se producen cuando el tejido vivo está en contacto durante un largo periodo con un objeto o sustancia caliente. Se describen varias áreas de participación, que varían de acuerdo con el potencial de reversión de la lesión, como la zona de coagulación, estasis e hiperemia. Con respecto a la profundidad de la lesión, pueden ser clasificadas de acuerdo a el espesor, en superficial, superficial parcial, parcial profunda y completa. La extensión de piel afectada se calcula en base a la "regla de los nueves", que establece que cada parte del cuerpo corresponde a un múltiplo de 9% de la superficie corporal total. Aunque es poco frecuente en los pacientes veterinarios, quemaduras graves pueden llevar a un shock al disminuir el flujo de sangre periférica. Se debe realizar como terapia tópica inicial la tricotomia amplia seguida de la aplicación de solución salina fria, lavar con solución isotónica estéril, debridamiento, aplicación de ungüento antimicrobiano como sulfadiazina de plata y cubrir con vendas húmedas no adherentes. El debridamiento del tejido desvitalizado debe realizarse lo antes posible y, preferentemente, de forma agresiva. En la imposibilidad de realización de cirugía se puede utilizar los agentes conservadores enzimáticos de debridamiento, la inmersión en el agua y la aplicación de vendajes húmedos-húmedas. Después de la formación del lecho vascular sin tejido necrótico o infectado, quemaduras extensas se pueden cerrar mediante colgajos, injertos de piel, la técnica de avance de piel, o tratadas como herida abierta hasta que sea posible el tratamiento quirúrgico. Pueden ocurrir complicaciones como infección, cicatrización excesiva y la contractura de la herida, sobre todo cuando no hay un tratamiento temprano. [...]
Burns occur when living tissues are in contact for a long period with a heated object or substance. Various zones of involvement are described, ranging as the reversal potential of the lesion, they are the zone of coagulation, stasis and hyperemia. Regarding the depth of the lesion, they can be graded according to the thikness, as superficial, superficial partialthickness, deep partial-thickness and full-thickness. The extent of affected skin can be calculated based on the Rule of Nines, which states that each part of the body corresponds to a multiple of 9% of the total body surface. Although rare in veterinary patients, severe burns can lead to shock by decreasing of peripheral blood flow. Wide hair removal, followed by application of cold saline solution, lavage with sterile isotonic solution, debridement, application of antimicrobial ointment as silver sulfadiazine and cover with moist nonadherent dress must be performed as the initial topical therapy. The debridement of devitalized tissue should be performed as early as possible and preferably aggressively. The impossibility to performing the surgery, conservative debridement can be done with enzymatic agents, immersion in water and the application of wet-wet dress. After formation of a vascular bed free of necrotic and infected tissue, extensive burns can be closed by flaps, skin grafting techniques, skin advance techniques or treated as an open wound until surgical treatment can be possible. Complications as infection, excessive scarring and wound contracture can occur, especially when there is not early treatment. The final cosmetic result is usually satisfactory when there is surgical intervention and complete hair covering. Although rare in veterinary medicine, severe burns are challenging and unlike traumatic wounds, presents different features and therapeutic. The abundant literature nowadays is mostly human and more veterinary studies are necessary in this area.
Queimaduras ocorrem quando tecido vivo entra em contato por um longo período com um objeto ou substância aquecida. São descritas diversas zonas de acometimento, variando conforme o potencial de reversão da lesão, sendo elas a zona de coagulação, estase e hiperemia. Em relação à profundidade da lesão, estas podem ser graduadas conforme a espessura em superficial, parcial superficial, parcial profunda e total. A extensão de pele acometida pode ser calculada com base na regra dos nove, que determina que cada parte do corpo corresponde a um múltiplo de 9% do total da superfície corpórea. Apesar de raro nos pacientes veterinários, queimaduras graves podem levar ao choque por diminuição do fluxo sanguíneo periférico. Deve-se realizar como terapia tópica inicial a tricotomia ampla seguida da aplicação de solução salina gelada, lavagem com solução isotônica estéril, debridamento, aplicação de pomada antimicrobiana como sulfadiazina de prata e a cobertura com bandagens úmidas não aderentes. O debridamento de tecido desvitalizado deve ser realizado o mais precocemente possível e preferencialmente de forma agressiva. Na impossibilidade de realização da intervenção cirúrgica, pode-se realizar o debridamento conservativo com agentes enzimáticos, imersão em água e a aplicação de bandagens úmida-úmida. Após a formação do leito vascular livre de tecido necrótico e infectado, as queimaduras extensas podem ser fechadas por meio de retalhos, enxertos cutâneos, técnicas de avanço de pele ou ainda tratadas como ferida aberta até que o tratamento cirúrgico seja possível. Como complicações, podem ocorrer infecção, cicatrização excessiva e contratura da ferida, especialmente quando não há tratamento precoce. O resultado cosmético final normalmente é satisfatório quando há intervenção cirúrgica e recobrimento piloso completo. [...]
Assuntos
Animais , Gatos , Cães , Desbridamento , Queimaduras/terapia , Queimaduras/veterinária , Sulfadiazina de Prata/uso terapêutico , Ferimentos e Lesões/veterináriaRESUMO
The production and evaluation of cornstarch/cellulose acetate/silver sulfadiazine extrudate matrices are reported herein. The matrices were melt extruded under nine different conditions, altering the temperature and the screw speed values. The surface morphology of the matrices was examined by scanning electron microscopy. The micrographs revealed the presence of non-melted silver sulfadiazine microparticles in the matrices extruded at lower temperature and screw speed values. The thermal properties were evaluated and the results for both the biopolymer and the drug indicated no thermal degradation during the melt extrusion process. The differential scanning analysis of the extrudate matrices showed a shift to lower temperatures for the silver sulfadiazine melting point compared with the non-extruded drug. The starch/cellulose acetate matrices containing silver sulfadiazine demonstrated significant inhibition of the growth of Pseudomonas aeruginosa and Staphylococcus aureus. In vivo inflammatory response tests showed that the extrudate matrices, with or without silver sulfadiazine, did not trigger chronic inflammatory processes.
Assuntos
Celulose/análogos & derivados , Sulfadiazina de Prata/química , Amido/química , Animais , Antibacterianos/química , Antibacterianos/farmacologia , Celulose/química , Cromatografia Líquida de Alta Pressão , Interleucina-10/sangue , Interleucina-6/sangue , Pseudomonas aeruginosa/efeitos dos fármacos , Ratos , Ratos Wistar , Sulfadiazina de Prata/farmacologia , Espectroscopia de Infravermelho com Transformada de Fourier , Staphylococcus aureus/efeitos dos fármacosRESUMO
Ultraviolet B (UVB) irradiation mainly affects biological tissues by inducing an increase in reactive oxygen species (ROS) production which leads to deleterious outcomes for the skin, including pain and inflammation. As a protective strategy, many studies have focused on the use of natural products. The aim of this study was to investigate the effects of Aloe saponaria on nociceptive, inflammatory, and oxidative parameters in a model of UVB-induced sunburn in adult male Wistar rats. Sunburned animals were topically treated with vehicle (base cream), 1% silver sulfadiazine (positive control) or A. saponaria (10%) once a day for 6days. UVB-induced nociception (allodynia and hyperalgesia), inflammation (edema and leukocyte infiltration) and oxidative stress (increases in H2O2, protein carbonyl levels and lipid peroxidation and a decrease in non protein thiol content) were reduced by both A. saponaria and sulfadiazine topical treatment. Furthermore, A. saponaria or its constituents aloin and rutin reduced the oxidative stress induced by H2O2 in skin homogenates in vitro. Our results demonstrate that topical A. saponaria treatment displayed anti-nociceptive and anti-inflammatory effects in a UVB-induced sunburn model, and these effects seem to be related to its antioxidant components.
Assuntos
Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Extratos Vegetais/farmacologia , Saponaria/química , Pele/efeitos dos fármacos , Raios Ultravioleta , Analgésicos/química , Analgésicos/farmacologia , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/uso terapêutico , Antioxidantes/química , Antioxidantes/uso terapêutico , Cromatografia Líquida de Alta Pressão , Modelos Animais de Doenças , Emodina/análogos & derivados , Emodina/análise , Emodina/farmacologia , Emodina/uso terapêutico , Inflamação/tratamento farmacológico , Masculino , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/efeitos da radiação , Extratos Vegetais/química , Extratos Vegetais/uso terapêutico , Folhas de Planta/química , Folhas de Planta/metabolismo , Ratos , Ratos Wistar , Saponaria/metabolismo , Sulfadiazina de Prata/química , Pele/efeitos da radiação , Queimadura Solar/tratamento farmacológico , Fatores de TempoRESUMO
PURPOSE: Evaluation of the rheological, biological and therapeutic properties of a new topical formulation consisting of chitosan gel containing 1 percent silver sulfadiazine, as an alternative for the treatment of burn wounds. METHODS: An experimental study was done with 21 Wistar rats divided into three groups. Group I was treated with chitosan gel without the antimicrobial, group II was treated with chitosan gel with 1 percent silver sulfadiazine and group III was treated with commercially available 1 percent silver sulfadiazine cream. RESULTS: Due to its pseudoplastic characteristic and good bioadhesiveness, the chitosan gels showed a satisfactory retention time over the wounds. No statistical difference was found in the amount of drug released from the chitosan gel and commercially available cream, as well as in the healing time among the groups. Wounds treated with chitosan gel with silver sulfadiazine showed a higher fibroblast production and a better angiogenesis than in the other groups, which are important parameters on the evolution of the healing process. CONCLUSION: The topical use of chitosan gel in association with silver sulfadiazine ameliorated the neovascularization and inflammatory reaction in burn wounds. This new formulation showed advantageous rheological properties and efficient release of the drug.(AU)
OBJETIVO: Avaliar as propriedades reológicas, biológicas e terapêuticas de uma nova formulação de uso tópico, a partir de um gel de quitosana, contendo sulfadiazina de prata a 1 por cento, no tratamento de queimaduras. MÉTODOS: Foi realizado estudo experimental com 21 ratos Wistar distribuídos em três grupos de sete animais. As queimaduras dos animais do grupo I foram tratadas com gel de quitosana sem antimicrobiano, o grupo II foi tratado com gel de quitosana contendo sulfadiazina de prata 1 por cento e o grupo III foi tratado com creme de sulfadiazina de prata 1 por cento, comumente utilizado no tratamento de queimados. RESULTADOS: Devido às características pseudoplásticas e à boa bioadesividade, os géis de quitosana apresentaram um tempo de retenção satisfatório sobre as feridas. A liberação da sulfadiazina de prata, bem como o tempo de cicatrização, não foram estatisticamente diferentes. Feridas tratadas com o gel de quitosana contendo sulfadiazina de prata apresentaram uma maior produção de fibroblastos e uma melhor angiogênese, comparando-se com os outros grupos, fatores que indicaram uma maior evolução no processo de cicatrização. CONCLUSÃO: O uso tópico do gel de quitosana com sulfadiazina de prata a 1 por cento melhorou a neovascularização e a reação inflamatória em queimaduras e essa nova formulação mostrou boas propriedades reológicas associadas a eficiente liberação do fármaco.(AU)
Assuntos
Animais , Masculino , Ratos , Quitosana/uso terapêutico , Sulfadiazina de Prata/administração & dosagem , Queimaduras/terapia , Sistemas de Liberação de Medicamentos , Cicatrização , ReologiaRESUMO
PURPOSE: Evaluation of the rheological, biological and therapeutic properties of a new topical formulation consisting of chitosan gel containing 1 percent silver sulfadiazine, as an alternative for the treatment of burn wounds. METHODS: An experimental study was done with 21 Wistar rats divided into three groups. Group I was treated with chitosan gel without the antimicrobial, group II was treated with chitosan gel with 1 percent silver sulfadiazine and group III was treated with commercially available 1 percent silver sulfadiazine cream. RESULTS: Due to its pseudoplastic characteristic and good bioadhesiveness, the chitosan gels showed a satisfactory retention time over the wounds. No statistical difference was found in the amount of drug released from the chitosan gel and commercially available cream, as well as in the healing time among the groups. Wounds treated with chitosan gel with silver sulfadiazine showed a higher fibroblast production and a better angiogenesis than in the other groups, which are important parameters on the evolution of the healing process. CONCLUSION: The topical use of chitosan gel in association with silver sulfadiazine ameliorated the neovascularization and inflammatory reaction in burn wounds. This new formulation showed advantageous rheological properties and efficient release of the drug.
OBJETIVO: Avaliar as propriedades reológicas, biológicas e terapêuticas de uma nova formulação de uso tópico, a partir de um gel de quitosana, contendo sulfadiazina de prata a 1 por cento, no tratamento de queimaduras. MÉTODOS: Foi realizado estudo experimental com 21 ratos Wistar distribuídos em três grupos de sete animais. As queimaduras dos animais do grupo I foram tratadas com gel de quitosana sem antimicrobiano, o grupo II foi tratado com gel de quitosana contendo sulfadiazina de prata 1 por cento e o grupo III foi tratado com creme de sulfadiazina de prata 1 por cento, comumente utilizado no tratamento de queimados. RESULTADOS: Devido às características pseudoplásticas e à boa bioadesividade, os géis de quitosana apresentaram um tempo de retenção satisfatório sobre as feridas. A liberação da sulfadiazina de prata, bem como o tempo de cicatrização, não foram estatisticamente diferentes. Feridas tratadas com o gel de quitosana contendo sulfadiazina de prata apresentaram uma maior produção de fibroblastos e uma melhor angiogênese, comparando-se com os outros grupos, fatores que indicaram uma maior evolução no processo de cicatrização. CONCLUSÃO: O uso tópico do gel de quitosana com sulfadiazina de prata a 1 por cento melhorou a neovascularização e a reação inflamatória em queimaduras e essa nova formulação mostrou boas propriedades reológicas associadas a eficiente liberação do fármaco.
Assuntos
Animais , Masculino , Ratos , Queimaduras/tratamento farmacológico , Quitosana/administração & dosagem , Sulfadiazina de Prata/administração & dosagem , Cicatrização/efeitos dos fármacos , Administração Tópica , Queimaduras/metabolismo , Quitosana/química , Géis , Modelos Animais , Neovascularização Fisiológica/efeitos dos fármacos , Ratos Wistar , ReologiaRESUMO
Background: The treatment of burn injuries with Silver Sulfadiazine is used in many burn centers. Objective: Determine the duration of clinical reepithelization in children treated with enriched Silver Sulfadiazine, according to sex, age, neutral zone burned (thorax - abdomen - limbs without joint damage), extention, presence of infections, bandage adherence and derivation to rehabilitation. Method: Retrospective review of 263 clinical records during 2004 that fulfilled the items for inclusion (children age under 15 years-old, with burn injuries of partial thickness caused by scalding liquids, treated at COANIQUEM Acute Unit with Silver Sulfadiazine plus Lidocaine plus Vitamin A and not needing grafts). Normal and median position between period of clinical reepithelization and variables considered with p < 0.05 were proven. Results: The median for clinical reepithelization was 10 days (range 5 - 23); if rehabilitation was required: 15 days and not required: 9 days (p < 0.0001). Lower limbs, children under 5 years-old and girls need longer reepithelization time. 0.4%> cases presented infections and 1.1% gauze adherence. Conclusions: Duration of clinical reepithelization with enriched Silver Sulfadiazine, associated to low infection rate and few adverse effects make it highly efficient for ambulatory treatments.
Introducción: Tratamiento de quemaduras con sulfadiazina de plata, sigue siendo de uso frecuente en muchos centros. Objetivo: Determinar el tiempo de re-epitelización clínica en niños con quemaduras por líquidos calientes, tratados con sulfadiazina de plata, su variación según sexo, edad, zona neutra (tórax-abdomen, extremidades sin compromiso articular) extensión, presencia de infecciones, adherencia de aposito y derivación a rehabilitación. Metodología: Revisión retrospectiva de 263 fichas que cumplieron con requisitos de inclusión (niños < 15 años, con quemaduras causadas por líquidos calientes, de espesor parcial, ingresados al Policlínico de Agudos de COANIQUEM en 2004, tratados con sulfadiazina de plata más lidocaína y vitamina A, que no fueron injertados). Se probó normalidad y posición de medianas entre período de reepitelización y según las distintas variables, se utilizó distribución percentilar como medida de tendencia central y prueba de Kruskal Wallis para la comparación de los grupos considerando p < 0,05 significativo. Resultados: Mediana de reepitelización clínica fue de 10 días (rango 5-23) para grupo total; 15 días para los con derivación a rehabilitación y de 9 días para los que fueron dados de alta (p < 0,0001). Demoró más la reepitelización en extremidades inferiores, niños menores de 5 años y mujeres. 0,4% presentó infección y 1,1% gasa adherida. Conclusiones: Duración de reepitelización clínica con sulfadiazina de plata, sumada a la baja tasa de infección y escasos efectos adversos, aporta alta confiabilidad a este método en curaciones ambulatorias.