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Paracoccidioidomycosis (PCM) is a systemic mycosis with serious clinical consequences in which the use of antifungal drugs requires long-term treatment. Therefore, we studied the effect of low-level LASER therapy (LLLT) to evaluate its prospects as a complementary treatment for PCM and improve the clinical response to the disease. OBJECTIVES: Our study focused on the resolution of lesions caused by fungal infection using a subcutaneous air pouch model of infection. METHODS: We evaluated cell profile and cytokines, fungi viability, and the presence of fibroblasts and fibrocytes at the site of infection. Inoculation of P. brasiliensis (Pb) was performed using a subcutaneous air pouch model and the LLLT irradiation was performed on alternate days on the rear paws of mice for 10 days, after which the cells from the air pouch were collected and analyzed. RESULTS: In animals irradiated with LLLT, the influx of cells to the air pouch was reduced, but they were more activated and produced pro-inflammatory (IL-12, IL-17 and TNF-α) and neutrophil (PMN) activating cytokines (IL-8, GM-CSF and γ-IFN). A better resolution of the infection, evidenced by the reduction in the number of viable fungi with preserved morphology in the air pouch, and an increase in the number of fibrocytes, indicating a healing profile were also observed. CONCLUSION: LLLT decreased the influx of PMN, but those presents were highly activated, with increased fungicidal activity. LLLT irradiation also resulted in earlier cicatrization at the site of infection, leading to a better outcome of the infection. These data are favorable to the use of LLLT as a complementary therapy in PCM.

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Wound infections are feared complications due to their potential to increase healthcare costs and cause mortality since multidrug-resistant bacteria reduce treatment options. This study reports the development of a carbomer hydrogel containing biogenic silver nanoparticles (bioAgNPs) and its effectiveness in wound treatment. This hydrogel showed in vitro bactericidal activity after 2 h, according to the time-kill assay. It also reduced bacterial contamination in rat wounds without impairing their healing since the hydrogel hydrophilic groups provided hydration for the injured skin. The high number of inflammatory cells in the first days of the skin lesion and the greater degree of neovascularization one week after wound onset showed that the healing process occurred normally. Furthermore, the hydrogel-containing bioAgNPs did not cause toxic silver accumulation in the organs and blood of the rats. This study developed a bioAgNP hydrogel for the treatment of wounds; it has a potent antimicrobial action without interfering with cicatrization or causing silver bioaccumulation. This formulation is effective against bacteria that commonly cause wound infections, such as Pseudomonas aeruginosa and Staphylococcus aureus, and for which new antimicrobials are urgently needed, according to the World Health Organization's warning.

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Elucidar o potencial terapêutico do uso de plasma rico em plaquetas (PRP). Foi realizado um levantamento de dados sobre o assunto em estudo nas bases de dados: PubMed, SciELO e Google Acadêmico, em língua portuguesa e inglesa, sendo considerado apenas trabalhos científicos publicados no período de 2011 a 2022. Foram consultados no total dezessete artigos para compor a presente revisão. Os estudos evidenciam que o plasma rico em plaquetas possui capacidade de atuar na síntese e liberação de fatores de crescimento e citocinas, que auxiliam na ação anti-inflamatória e antibacteriana promovendo a regeneração tecidual. Os fatores de crescimento derivados de plaquetas atuam como agentes reguladoras e estimuladoras dos processos celulares de mitogênese, quimiotaxia, diferenciação e metabolismo. Essas propriedades das plaquetas conferem ao plasma rico em plaquetas uma potencialidade em melhorar a integração de enxertos cutâneos, ósseos, cartilaginosos ou de gordura, proporcionando uma proteção natural contra processos infecciosos. Os resultados em conjunto sugerem que a aplicação do PRP é considerada uma técnica segura, eficaz e confiável por ser um procedimento autólogo, trazendo avanços promissores quanto ao tempo deregeneração tecidual. O uso dessa técnica pode trazer enormes benefícios aos pacientes, mas ainda há necessidade de maiores estudos científicos, objetivando sempre o aprimoramento da técnica.

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Introducción: Los traumatismos constituyen causa frecuente de consulta. Entre sus localizaciones más comunes se encuentran las extremidades inferiores. El Heberprot-P® resulta un factor de crecimiento epidérmico que se ha utilizado durante más de una década para la cicatrización de las úlceras del pie diabético con excelentes resultados. Ampliar su utilización a otras patologías, incluso de etiología traumática, permitiría expandir las posibilidades terapéuticas para la cicatrización de las heridas. Objetivo: Exponer el resultado de la aplicación del Heberprot-P® en una amputación transtarsiana en un paciente portador de un trauma vascular distal. Presentación del caso: Paciente masculino de 23 años con antecedentes de salud. Luego de traumatismo por accidente de tránsito presentó fractura de huesos del metatarso y la sección total de la arteria pedia del pie izquierdo, lo cual provocó una gangrena húmeda de la extremidad. Por este motivo se realizó una amputación transtarsiana del pie. Se usó el Heberprot-P® como terapia para acortar el tiempo de cicatrización. Conclusiones: El Heberprot-P® resultó útil para la evolución de la herida como consecuencia de un trauma vascular, al evitar una amputación mayor, acelerar el proceso de cicatrización y conservar una extremidad funcional, lo que demostró que puede constituir una terapia eficaz para las heridas de difícil cicatrización, independientemente de su etiología(AU)

Introduction: Trauma is a frequent cause of consultation. Among its most common locations are the lower extremities. Heberprot-P® is an epidermal growth factor that has been used for more than a decade for the healing of diabetic foot ulcers with excellent results. Extending its use to other pathologies, including traumatic etiology ones, would expand the therapeutic possibilities for wound healing. Objective: To present the result of the application of Heberprot-P® in a Chopart´s amputation in a patient with distal vascular trauma. Case presentation: A 23-year-old male patient with a health history. After trauma from a traffic accident, he presented a fracture of the bones of the metatarsus and the whole section of the left foot´s pedis artery, which caused a wet gangrene of the extremity. For this reason, a Chopart´s amputation of the foot was performed. Heberprot-P® was used as therapy to shorten healing time. Conclusions: Heberprot-P® was useful for wound evolution as a result of vascular trauma, avoiding major amputation, accelerating the healing process and preserving a functional limb, which showed that it can be an effective therapy for wounds that are difficult to heal, regardless of their etiology(AU)

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An intense effort has been focused on new therapeutic approaches and the development of technologies for more efficient and rapid wound healing. The research for plants used for long time in traditional medicine in the treatment of wound has become a promising strategy to obtain drugs therapeutically useful in the acute and chronic wound management. In this context, Centella asiatica (Apiaceae) has been used to treat a variety of skin diseases, such as leprosy, lupus, varicose ulcers, eczema and psoriasis, in Asiatic traditional medicine for thousands of years. Studies have shown that Centella asiatica extracts (CAE) display activity in tissue regeneration, cell migration and wound repair process by promoting fibroblast proliferation and collagen synthesis. Preliminary findings have shown that the asiatic acid is one of the main active constituents of C. asiatica, directly associated with its healing activity. Thus, this study discusses aspects of the effects of Centella asiatica and its active component, asiatic acid, in different stages of the healing process of cutaneous wounds, including phytochemical and antimicrobial aspects that contribute to its therapeutic potential.

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Graphene quantum dots (GQDs), are biocompatible materials, with mechanical strength and stability. Chitosan, has antibacterial and anti-inflammatory properties, and biocompatibility. Wound healing is a challenging process especially in chronic diseases and infection. In this study, films consisting of chitosan and graphene quantum dots were developed for application in infected wounds. The chitosan-graphene films were prepared in the acidic solution followed by slow solvent evaporation and drying. The chitosan-graphene films were characterized by the scanning electron microscopy, x-ray diffraction, atomic force microscopy, Raman spectroscopy and thermogravimetric analysis. The films' was evaluated by the wound healing assays, hemolytic potential, and nitrite production, cytokine production and swelling potential. The obtained films were flexible and well-structured, promoting cell migration, greater antibacterial activity, lower hemolytic activity, and maintaining wound moisture. Our data suggested that the use of graphene quantum dot-containing chitosan films would be an efficient and promising way in combating wounds.

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Hamster breeding is becoming increasingly popular, mainly because of the simplicity of breeding, low cost, and characteristics of these animals: they are small, quiet, and do not require a large space. Because of this ease of keeping, some people choose to keep more than one animal of the same species in a single enclosure. In some cases, this sociability can lead to fights, because hamsters are extremely territorial animals, which can cause significant injuries. Knowledge of the most efficient methods for wound healing is essential in medicine for wild and exotic animals, as it allows faster clinical treatment and thus, stress reduction. The present case report refers to the therapeutic treatment of an extensive skin lesion in a golden hamster (Mesocricetus auratus) using ozonized sunflower oil. The treatment, which lasted 23 days, allowed complete healing of the lesion.

A criação de hamsters tem se tornado cada vez mais popular, especialmente pela facilidade de criação, pelo baixo custo e pelas características desses animais: são pequenos, silenciosos, e não necessitam de um grande espaço. Por essa facilidade de manejo, algumas pessoas decidem manter mais de um animal da mesma espécie em um único recinto. Em alguns casos, esse convívio pode causar brigas, visto que hamsters são animais extremamente territorialistas, podendo resultar em injúrias cutâneas significativas. O conhecimento sobre os métodos mais eficientes para a cicatrização de lesões é fundamental na medicina de animais silvestres e exóticos, possibilitando um manejo clínico mais rápido, consequentemente, redução do estresse. O presente relato refere-se ao manejo terapêutico de uma extensa lesão cutânea em um hamster sírio (Mesocricetus auratus) com o uso do óleo de girassol ozonizado. O tratamento, que teve 23 dias de duração, possibilitou a cicatrização total da lesão.

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Resumen Objetivo: Reportar un caso sobre el uso de la terapia de presión negativa como tratamiento alternativo en el manejo de una úlcera vascular arterial de miembros inferiores. Métodos: Por medio de la historia clínica, se revisó los registros previos de una paciente en un centro de atención médica de tercer nivel en Popayán, Colombia. Posteriormente, se realizó una revisión sistemática bibliográfica a través de las bases de datos de Pubmed, ScienceDirect y Scielo. Resultados: La terapia de presión negativa favoreció el proceso de cicatrización, permitiendo el cierre de la herida. Conclusiones: Actualmente, este sistema se considera un apoyo fundamental en el tratamiento de las heridas complejas, las cuales suponen un reto terapéutico importante.

Abstract Objective: To report a case about the use of the Negative-pressure wound therapy as an alternative treatment for arterial vascular ulcers presented in the lower limbs. Methods: The patient's records were reviewed based on her medical history in a tertiary referral care center in Popayan, Colombia. Subsequently, a systematic literature review was conducted through the Pubmed database, ScienceDirect, and Scielo. Results: The use of Negative-pressure wound therapy favored the lesion healing process. Conclusions: Nowadays, this system is considered as an essential treatment for complex wounds, which represent a major therapeutic challenge.

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Cutaneous lesions lead to complications in patients, since they may be recurrent and also represent risk of progression to infection and/or amputation. Therefore, effective, protective, and topical treatments of easy application and removal need to be developed to provide effective alternatives to patients. The Caryocar brasiliense Cambess (CBC) presents important pharmacological activities and proved in the healing process. This paper reports the improvement of the CBC nanostructured (LNCCBC and LNCCBC+) activity in dermal wounds in vivo. The oil was physico-chemically characterized and used in the development of lipid-core nanocapsules (LNCs), coated (LNCCBC+) or without chitosan (LNCCBC), in concentration of 1.0 mg mL-1. Hydrogel (HG) was tested in vivo on lesions in the back of male Wistar rats for 14 days. The oil presented appropriate physico-chemical characteristics for its use, such as moisture 0.76 %, acidity 0.85 % and oleic acid 25.90 %. The LNCs showed nanometric size (around 200 nm), monomodal distribution, slight acid pH and zeta potential of + 22.1 mV in accordance with the composition. The nanostructured oil induced dermal healing in vivo showing significantly better improvement than free oil. LNCCBC+ showed best results showing the higher increase of the production of type 1 collagen, an important protein to the healing repair. These results suggest that development of formulations LNCCBC and LNCCBC+ are promising and important alternative for the treatment of dermal wounds, avoiding complications related to cutaneous lesions.

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Chronic wounds are a remarkable cause of morbidity, requiring long-time treatments with a significant impact on the quality of life and high costs for public health. Although there are a variety of topical skin preparations commercially available, they have several limitations that frequently impair wound healing, such as drug instability, toxicity, limited time of action and ineffective skin permeation. In recent years, researchers have focused on the development of new effective treatments for wound healing and shown frequent interest in nanometric drug delivery systems to overcome such obstacles. In dermatology, lipid nanoparticles (LNPs) have received great attention from researchers due to their great functionalities, greater adhesion to the skin and film formation, enabling the hydration and maintenance of skin integrity, as well as present a more effective penetration through the skin barrier. This review provides an update on topical formulations based on Solid Lipid Nanoparticles (SLNs) and Nanostructured Lipid Carriers (NLCs) as wound healing treatments. Both SLNs and NLCs are able to increase solubility and stability of active pharmaceutical ingredients and increase skin penetration compared to the free drugs. Additionally, SLNs and NLCs can increase pharmacological activity, increase the release profile of the drugs, promote synergistic effects and improve the sensory properties of the final formulation. Topical dosage forms containing nanoparticles have been extensively evaluated for wound healing activity, mainly the dressings, films and scaffolds. Therefore, lipid nanoparticles have contributed in improving wound healing therapies when incorporated into other dosage forms with better efficacy and lesser adverse effects than conventional formulations.

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RESUMEN La leishmaniosis es una enfermedad con gran impacto en salud pública dado a las características de las lesiones tegumentarias. El tratamiento experimental con terapia larval (TL) ha mostrado su uso potencial para la cura de la leishmaniosis, sin embargo, se han utilizado especies de moscas para TL en heridas causadas por Leishmanial que no son de fácil colecta y cultivo bajo condiciones de laboratorio como Lucilia sericata o Calliphora vicina. El objetivo del presente trabajo fue usar una especie de mosca de fácil colecta, y de alta fecundidad como la Musca domestica para aplicarlas en TL de úlceras leishmánicas. Se realizó un estudio cuali-cuantitativo, de tipo descriptivo, mediante un diseño experimental empleado un modelo animal (Mesocricetus auratus), infectado con Leishmania amazonensis para evaluar el efecto terapéutico de la TL y comparar los resultados con el tratamiento químico antimonial de la droga experimental "Ulamina". Se evidencia cicatrización y cura de la úlcera leishmánica en el 66,66 % de los animales tratados con TL en aplicación simple y del 100 % en TL combinada con Ulamina. El uso combinado de TL+Ulamina, muestra un efecto potenciador de la cura clínica de las úlceras, pero con persistente inflamación. Se observó una efectividad óptima de la TL con M. domestica, sobre las úlceras, aunque no se evidenció un efecto sobre L. amazonensis dado a la presencia de amastigotes en los frotis y a los amplicones obtenidos de 480 bp desde las improntas de los animales.

ABSTRACT Leishmaniasis is a disease with significant impact on public health, given the characteristics of the tegumentary lesions. Experimental treatment with larval therapy (LT) has shown its potential use for the cure of leishmaniosis. However, fly species not easy to collect and/or colonize have been used. The objective of the present work was to use a fly of accessible collection and high fecundity, not a producer of human myiasis, such as Musca domestica. A qualitative-quantitative study of a descriptive type was carried out through an experimental design with an animal model (Mesocricetus auratus) with infection by Leishmania amazonensis to evaluate the therapeutic effect of LT and compare the results with the antimonial chemical treatment of the drug experimental "Ulamina". Scarring were observed with the use of LT in 66.66 % with TL-simple and 100 % with TL-combined. However, the combined use of LT + Ulamina, shows an enhancing effect of the clinical cure of the lesions, but with persistent inflammation. Optimal effectiveness of TL with M. domestica was observed on the ulcers; however, an effect on L. amazonensis was not observed given the presence of amastigotes in the smears and the 480 bp amplicons from the tissue of the ulcers of animals.

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O emprego conjunto da laserterapia e da ozonioterapia em feridas apresenta alto potencial benéfico para os pacientes, uma vez que contribui para o manejo da dor, tem ação anti-inflamatória e acelera o processo de cicatrização. Este relato de caso tem como objetivo apresentar o uso de terapias alternativas na cicatrização de ferida em exemplar de Coendou prehensilis. Um ouriço-cacheiro, fêmea, adulto, com peso de 4kg foi encaminhado para atendimento médico veterinário com histórico de ter sido atacado por um cão. Inicialmente o ouriço passou pelo procedimento de higienização e desbridamento da ferida, para a retirada das bordas necróticas. Adicionalmente, foram administrados clindamicina (10mg/kg), por via intramuscular (IM), uma vez por dia (SID), tramadol (4mg/kg, IM, SID), flunixin (0,3mg/kg, SID), por via subcutânea (SC), e ferrodextrano (25mg/kg, IM, SID). Apesar da terapia instituída, observou-se reincidência de crescimento necrótico tecidual, o que levou à eleição do tratamento da ferida com as técnicas de laserterapia e ozonioterapia. O emprego das terapias alternativas como adjuvante promoveu uma cicatrização satisfatória da ferida, com ausência de sinais de sensibilidade local e de infecção, bem como ausência de crescimento de bordas necróticas. O tratamento adjuvante foi eficaz e pode ser empregado em outras situações para cicatrização de ferida em mamíferos silvestres.(AU)

The use of therapy with laser beam and ozone in wounds has a high beneficial potential for patients, since it contributes to the management of pain, has an anti-inflammatory action and accelerates the cicatricial process. Due to this casuistry importance, the case report aims to present alternative therapy use for wound healing on a Coendou prehensilis. Thus, a female of C. prehensilis weighing 4kg, was sent to veterinary care. At first there was a hygiene process and debridement for necrotic edge removal. Furthermore, injected clindamycin (10mg/kg) was administered intramuscularly (IM), once a day (SID), tramadol (4mg/kg, IM, SID), flunixin (0.3mg/kg, SID), administered subcutaneously (SC) and iron dextran (25mg/kg, IM, SID). In spite of the established therapy, tissue necrotic growth was observed, which lead the wound treatment as healing by second intention, initiating an alternative therapy with laser beam and ozone. As a result, the healing was satisfactory due to the elected techniques, without signs of pain and infection. The adjuvant treatment with physiotherapy had advantageous effect and could be applied to wound healing in wild mammal animals.(AU)

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O emprego conjunto da laserterapia e da ozonioterapia em feridas apresenta alto potencial benéfico para os pacientes, uma vez que contribui para o manejo da dor, tem ação anti-inflamatória e acelera o processo de cicatrização. Este relato de caso tem como objetivo apresentar o uso de terapias alternativas na cicatrização de ferida em exemplar de Coendou prehensilis. Um ouriço-cacheiro, fêmea, adulto, com peso de 4kg foi encaminhado para atendimento médico veterinário com histórico de ter sido atacado por um cão. Inicialmente o ouriço passou pelo procedimento de higienização e desbridamento da ferida, para a retirada das bordas necróticas. Adicionalmente, foram administrados clindamicina (10mg/kg), por via intramuscular (IM), uma vez por dia (SID), tramadol (4mg/kg, IM, SID), flunixin (0,3mg/kg, SID), por via subcutânea (SC), e ferrodextrano (25mg/kg, IM, SID). Apesar da terapia instituída, observou-se reincidência de crescimento necrótico tecidual, o que levou à eleição do tratamento da ferida com as técnicas de laserterapia e ozonioterapia. O emprego das terapias alternativas como adjuvante promoveu uma cicatrização satisfatória da ferida, com ausência de sinais de sensibilidade local e de infecção, bem como ausência de crescimento de bordas necróticas. O tratamento adjuvante foi eficaz e pode ser empregado em outras situações para cicatrização de ferida em mamíferos silvestres.(AU)

The use of therapy with laser beam and ozone in wounds has a high beneficial potential for patients, since it contributes to the management of pain, has an anti-inflammatory action and accelerates the cicatricial process. Due to this casuistry importance, the case report aims to present alternative therapy use for wound healing on a Coendou prehensilis. Thus, a female of C. prehensilis weighing 4kg, was sent to veterinary care. At first there was a hygiene process and debridement for necrotic edge removal. Furthermore, injected clindamycin (10mg/kg) was administered intramuscularly (IM), once a day (SID), tramadol (4mg/kg, IM, SID), flunixin (0.3mg/kg, SID), administered subcutaneously (SC) and iron dextran (25mg/kg, IM, SID). In spite of the established therapy, tissue necrotic growth was observed, which lead the wound treatment as healing by second intention, initiating an alternative therapy with laser beam and ozone. As a result, the healing was satisfactory due to the elected techniques, without signs of pain and infection. The adjuvant treatment with physiotherapy had advantageous effect and could be applied to wound healing in wild mammal animals.(AU)

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Anal sphincter spasm contributes to the delay in surgical wound healing after hemorrhoidectomy. A prospective, experimental, randomized, double-blind trial was conducted on two groups of patients that underwent closed hemorrhoidectomy. There were 26 patients in each group. Group A received topical diltiazem in the anal region three times a day. Group B received a placebo. Cicatrization time was documented for 6 weeks through digital photography. Mean healing time for the group treated with diltiazem was 3.19 weeks (22.33±0.884 days) and 3.92 weeks (27.44±1.130 days) for the control group (p=0.012 95% CI). At week three, the wounds in 73.07% of the patients in the diltiazem group had healed, compared with 46.15% of the patients in the control group.

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Cutaneous leishmaniasis (CL) treatment is based on therapy with Glucantime® , yet, there are few laboratory methods to monitor its success. In this study, ex vivo and in vitro evaluations of peripheral blood monocytes were performed in a longitudinal study to characterize the impact of Glucantime® on overall phenotypic/functional features of these cells from CL patients to identify predictive biomarkers for post-therapeutic monitoring by flow cytometry. The ex vivo evaluation from CL patients demonstrated a modulatory profile before treatment, with a decrease in TLR-2, FcγRII, HLA-DR, CD86, IFN-γR, TNF, IL-12, NO, and an increase in FcγRIII and IL-10R. Conversely, treatment changes some of these biomarker expressions by decreasing FcγRIII and IL-10R and increasing IFN-γR, IL-12 and NO. Moreover, an in vitro analysis of these patients showed a reduced phagocytic capacity of Leishmania braziliensis and higher levels of IL-10 and TGF-ß modulating functional profile. Regardless of the compromised L. braziliensis phagocytic capacity, treatment re-established the production of IL-12, IL-10, TGF-ß and NO at the basal level. Notably, monocytes from patients with early cicatrization showed enhanced FcγRI and FcγRII expressions and reduced IL-10, which was further corroborated by a baseline fold change analysis. Finally, the logistic regression model emphasized the performance of FcγRI, FcγRII and IL-10 as robust predictive biomarkers for post-therapeutic cicatrization during cutaneous leishmaniasis.

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RESUMEN: Introducción: Independientemente de su etiología, las heridas crónicas, representan un desafío terapéutico debido a que muchas veces son refractarias a tratamientos convencionales. Es por este motivo que en los últimos años se han desarrollado de forma creciente estrategias complementarias en el área de la medicina regenerativa, como: terapias con células madre, ingeniería de tejidos, plasma rico en plaquetas y factores de crecimiento aplicados en las heridas crónicas. Dichas terapias complementarias han mostrado ciertos beneficios en la cicatrización de heridas complejas. Materiales y métodos: Se presentan dos casos clínicos de pacientes con heridas crónicas de diferente etiología, refractarias al tratamiento con cura avanzada de heridas, las cuales recibieron de forma complementaria factor estimulante de colonias de granulocitos (G-CSF; Filgen®). Se realizaron inyecciones locales de G-CSF a una dosis de 300 mcg/ml en piel peri úlcera en forma semanal completando dos series de cuatro inyecciones cada una. Resultados. Ambos casos presentaron una reducción en el área de las mismas alcanzándose la cicatrización total en un paciente y una reducción del 37% en el otro luego de dos series. El procedimiento fue bien tolerado y no se reportaron efectos adversos relacionados al mismo. Conclusiones: Los resultados obtenidos en estos pacientes mostraron beneficios en la cicatrización con la aplicación del G-CSF. Se requieren de ensayos clínicos controlados que permitan establecer el rol de dicho factor en el tratamiento de las mismas. Por este motivo nuestro grupo de trabajo se encuentra desarrollando un protocolo que permita evaluar este aspecto.

ABSTRACT: Introduction: Regardless of their etiology, chronic wounds, represent a therapeutic challenge because they are often refractory to conventional treatments. Due to this observation, in the last few years, new complementary strategies have emerged in the area of regenerative medicine, including stem cell therapeutics, tissue engineering, platelet rich plasma, and growth factors applied to chronic wounds. These complementary therapies have shown certain benefits in healing of complex wounds. Materials and methods: We present two clinical cases of patients with chronic wounds of different etiology, refractory to advanced and conventional wound treatments, which received complementary granulocyte colony-stimulating growth factor (G-CSF; Filgen®). Local injections with G-CSF were administered weekly in periulcer skin at a dose of 300 mcg/ml, completing two series of four injections each. Results: Both cases showeda reduction in their areas, reaching to total healing inone patient, and a reduction of 37% in the other one after two series of treatment. The procedure was well tolerated and no adverse effects were detected. Conclusions: The results obtained with these patients showed a benefit in cicatrization with the administration of G-CSF. Controlled clinical trials are needed to establish the role of G-CSF in these wounds. Thus, our group is developing a protocol to evaluate this aspect.

RESUMO: Introdução: Independentemente da sua etiologia, as feridas crônicas representam um desafio terapêutico porque muitas vezes são refratárias aos tratamentos convencionais. É por esta razão que nos últimos anos foram desenvolvidas estratégias complementares na área da medicina regenerativa, tais como: terapias de células estaminais, engenharia de tecidos, plasma rico em plaquetas e fatores de crescimento aplicados a feridas crônicas. Tais terapias complementares mostraram certos benefícios na cicatrização de feridas complexas. Materiais e métodos: Dois casos de pacientes com feridas crónicas de diferentes etiologias, refractárias ao tratamento com a cura da ferida avançado, que receberam complementaria factor estimulante forma de colónias de granulócitos (Filgen® FEC-G) presente. As injeções locais de G-CSF foram feitas a uma dose de 300 mcg / ml na pele peri úlcera, semanalmente, completando duas séries de quatro injeções cada. Resultados: Ambos os casos mostraram uma redução na área do mesmo atingindo a cicatrização total em um paciente e uma redução de 37% no outro após duas séries. O procedimento foi bem tolerado e nenhum efeito adverso relacionado a ele foi relatado. Conclusões: Os resultados obtidos nestes pacientes mostraram benefícios na cura com a aplicação de G-CSF. Ensaios clínicos controlados são necessários para estabelecer o papel desse fator no tratamento deles. Por esse motivo, nosso grupo de trabalho está desenvolvendo um protocolo que nos permite avaliar esse aspecto.

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BACKGROUND: Bariatric surgery is a successful method for weight loss in cases of morbid obesity; however, as an invasive procedure, surgical complications may occur. Low-level laser therapy (LLLT) has been increasingly used due to its effectiveness in controlling the inflammatory response, accelerating tissue repair, and reducing pain. The objective of this study was to investigate photobiomodulation effects after bariatric surgery and determine the laser actions during the inflammatory process, wound healing (clinical observation), and analgesia. METHODS: This study was a randomized, placebo-controlled, clinical trial in which 85 patients underwent Roux en-Y gastric bypass (RYGB) by conventional techniques (i.e., open surgery). Patients were divided into two groups and were irradiated with LLLT at 10 different points through the surgical scar in three sessions of applications: the laser group (laser-on) consisted of 43 patients who received the CW diode laser (MMOptics), while the placebo group (laser-off) consisted of 42 patients who were treated by the same protocol but with a disabled laser. Temperature was measured by a digital thermometer in both groups, and pain was evaluated using the visual analogue scale for pain. Biochemical analysis and digital images were used to document and evaluate the inflammatory response as well as tissue repair process at the surgical wound site. RESULTS: Patients in the laser group demonstrated diminished wound temperature as erythrocyte sedimentation rate (ESR) compared with the placebo group, indicating better inflammatory process control as well as improved wound healing and reduced pain. CONCLUSIONS: LLLT applied with the described protocol led to a decrease by biochemical markers and wound temperature compared with the placebo, which indicated that LLLT was able to control the inflammatory process; in addition, seroma and pain were reduced and cicatrization was improved by this preventive procedure.

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Chitosan is a natural polymer with antibacterial property, that is biodegradable, extremely abundant and non-toxic. This study aimed to develop and characterize chitosan hydrogels in combination with nerolidol, in order to optimize the antimicrobial and healing properties. The hydrogels were prepared using a reaction of the chitosan with acetic acid solution, followed by the addition of 2 or 4% of the nerolidol. Using thermogravimetry, differential scanning calorimetry and infrared spectroscopy, the incorporation of nerolidol in the hydrogel was confirmed. Direct contact tests using hydrogels and Staphylococcus aureus showed a synergistic effect in the materials, enabling total inhibition of bacterial growth. The hydrogel containing 2% nerolidol showed excellent healing effects. The beginning of re-epithelialization and reorganization of collagen was already observed on the 7th day of treatment. The material created proofed to be promising as a healing and antibacterial agent.

Assuntos

RESUMO

Chronic cutaneous lesions affect 15% of diabetic human patients and represent a risk 15 to 46 times larger of limb amputations compared to people with normal glycemia. It is assumed that half of these amputations could be prevented by early treatment of wounds, for example, with proper cell therapy. Objectives: In this study, the action of the autologous transplant of mesenchymal stem-cells (MSC) was evaluated compared to the treatment with autologous platelet rich plasma (PRP) in the cicatrization of cutaneous lesions induced in diabetic mice. These animals were previously treated with streptozootocin to induce diabetes mellitus and round wounds of 1.5cm in diameter were created in the posterior region. Diameters of the wounds and healing time were evaluated during 30 days and the results were submitted to variance analysis and Tukey's test average. It was noticed that the animals treated with MSC presented a more accelerated cicatrization of the cutaneous lesion than the animals treated with PRP. However, the treatment with PRP presented better results than just the daily asepsis of the lesions with saline or covering them with semi-permeable bandage. Besides, the use of semi-permeable bandage kept the cutaneous lesions of diabetic mice did not interfere negatively with cicatrization, proved to be harmless to use, but kept the cutaneous lesions more hydrated than the ones exposed to the environment.(AU)

Lesões cutâneas crônicas afetam 15% dos pacientes diabéticos e humanos representam um risco 15 a 46 vezes maior de amputações de membros em comparação com as pessoas com a glicemia normal. Supõe-se que a metade destas amputações poderia ser evitada por meio do tratamento precoce das feridas cutâneas com, por exemplo, uma adequada terapia celular. Objetivos: Neste estudo, a ação do transplante autólogo de células estaminais mesenquimais (MSC) foi avaliada em comparação com o tratamento com plasma rico em plaquetas autólogo (PRP) na cicatrização de lesões cutâneas induzidas em camundongos diabéticos. Estes animais foram previamente tratados com estreptozotocina para induzir diabetes mellitus e feridas redondas de 1,5 cm de diâmetro foram criadas na região posterior. Os diâmetros dos ferimentos e tempo de cicatrização foram avaliados durante 30 dias e os resultados foram submetidos à análise de variância e média pelo teste de Tukey. Verificou-se que os animais tratados com MSC apresentam uma cicatrização mais acelerada da lesão cutânea que do que os animais tratados com PRP. No entanto, o tratamento com PRP apresentou melhores resultados do que apenas a assepsia das lesões diariamente com solução salina ou cobrindo-os com atadura semi-permeável. Além disso, a utilização de atadura semi-permeável mantidas as lesões cutâneas de camundongos diabéticos não interfere negativamente com a cicatrização, provou ser inofensiva para usar, mas manteve as lesões cutâneas hidratadas mais do que os expostos ao meio ambiente.(AU)

Assuntos

RESUMO

Chronic cutaneous lesions affect 15% of diabetic human patients and represent a risk 15 to 46 times larger of limb amputations compared to people with normal glycemia. It is assumed that half of these amputations could be prevented by early treatment of wounds, for example, with proper cell therapy. Objectives: In this study, the action of the autologous transplant of mesenchymal stem-cells (MSC) was evaluated compared to the treatment with autologous platelet rich plasma (PRP) in the cicatrization of cutaneous lesions induced in diabetic mice. These animals were previously treated with streptozootocin to induce diabetes mellitus and round wounds of 1.5cm in diameter were created in the posterior region. Diameters of the wounds and healing time were evaluated during 30 days and the results were submitted to variance analysis and Tukey's test average. It was noticed that the animals treated with MSC presented a more accelerated cicatrization of the cutaneous lesion than the animals treated with PRP. However, the treatment with PRP presented better results than just the daily asepsis of the lesions with saline or covering them with semi-permeable bandage. Besides, the use of semi-permeable bandage kept the cutaneous lesions of diabetic mice did not interfere negatively with cicatrization, proved to be harmless to use, but kept the cutaneous lesions more hydrated than the ones exposed to the environment.(AU)

Lesões cutâneas crônicas afetam 15% dos pacientes diabéticos e humanos representam um risco 15 a 46 vezes maior de amputações de membros em comparação com as pessoas com a glicemia normal. Supõe-se que a metade destas amputações poderia ser evitada por meio do tratamento precoce das feridas cutâneas com, por exemplo, uma adequada terapia celular. Objetivos: Neste estudo, a ação do transplante autólogo de células estaminais mesenquimais (MSC) foi avaliada em comparação com o tratamento com plasma rico em plaquetas autólogo (PRP) na cicatrização de lesões cutâneas induzidas em camundongos diabéticos. Estes animais foram previamente tratados com estreptozotocina para induzir diabetes mellitus e feridas redondas de 1,5 cm de diâmetro foram criadas na região posterior. Os diâmetros dos ferimentos e tempo de cicatrização foram avaliados durante 30 dias e os resultados foram submetidos à análise de variância e média pelo teste de Tukey. Verificou-se que os animais tratados com MSC apresentam uma cicatrização mais acelerada da lesão cutânea que do que os animais tratados com PRP. No entanto, o tratamento com PRP apresentou melhores resultados do que apenas a assepsia das lesões diariamente com solução salina ou cobrindo-os com atadura semi-permeável. Além disso, a utilização de atadura semi-permeável mantidas as lesões cutâneas de camundongos diabéticos não interfere negativamente com a cicatrização, provou ser inofensiva para usar, mas manteve as lesões cutâneas hidratadas mais do que os expostos ao meio ambiente.(AU)

Assuntos