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Pallett SJ, Mistry R, Lambert ZL, Woolley SD, Abbara A, Breathnach AO, Lamb LE, Williams A, Mughal N, Moshynets O, Hughes SJ, O'Shea MK, Moore LS. Conflict and catastrophe-related severe burn injuries: A challenging setting for antimicrobial decision-making. J Infect 2024; 89:106224. [PMID: 38986748 DOI: 10.1016/j.jinf.2024.106224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Severe burns are a major component of conflict-related injuries and can result in high rates of mortality. Conflict and disaster-related severe burn injuries present unique challenges in logistic, diagnostic and treatment options, while wider conflict is associated with driving local antimicrobial resistance. We present a targeted review of available literature over the last 10 years on the use of systemic antimicrobial antibiotics in this setting and, given limited available data, provide an expert consensus discussion. While international guidelines do not tend to recommend routine use of prophylactic systemic antibiotics, the challenges of conflict settings and potential for polytrauma are likely to have ongoing impacts on antimicrobial decision-making and use. Efforts must be made to develop a suitable evidence base in this unique setting. In the interim, a pragmatic approach to balancing selective pressures of antimicrobial use with realistic access is possible.
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Affiliation(s)
- Scott Jc Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK.
| | - Rakhee Mistry
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Zoe L Lambert
- Britannia Royal Navy College Dartmouth, College Way, Dartmouth, Devon TQ6 0HJ, UK
| | - Stephen D Woolley
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Aula Abbara
- Faculty of Medicine, Department of Infectious Diseases, Imperial College Praed Street, London W2 1NY, UK
| | - Aodhan O Breathnach
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK; International Health Regulations Strengthening Project, UK Health Security Agency, South Colonnade Canary Wharf, London E14 4PU, UK
| | - Lucy E Lamb
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Infectious Diseases Department, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - Andrew Williams
- Burns Unit, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Nabeela Mughal
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Olena Moshynets
- Institute of Molecular Biology and Genetics of National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
| | - Stephen J Hughes
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Matthew K O'Shea
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Luke Sp Moore
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
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Łabuś W, Kitala D, Navarro A, Klama-Baryła A, Kraut M, Sitkowska A, Smętek W, Kamiński A. The urgent need to achieve an optimal strategic stock of human allogeneic skin graft materials in case of a mass disaster in Poland. Cell Tissue Bank 2022; 23:863-885. [PMID: 35355193 PMCID: PMC8967378 DOI: 10.1007/s10561-022-10001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/27/2022] [Indexed: 12/03/2022]
Abstract
A burn is a sudden injury which immediate or long-term consequences may be life-threatening for the patient. A mass disaster event may involve large numbers of severely burned patients. Patients of this type typically have a limited area of healthy, unburned skin from which an autologous split thickness skin graft could be collected. In a clinical situation of this type, it is necessary to use a particular skin substitute. Non-viable allogeneic human skin graft materials might be considered as the most suitable skin substitutes in the treatment of such patients. At present, Poland does not have a sufficient supply of human allogeneic skin graft materials to meet the needs arising from a sudden and unforeseen mass disaster. This study involved an analysis of selected mass disasters. From this an estimate was made from a verified casualty profile of the necessary minimum stock of human allogeneic skin graft materials. An insufficient amount of skin results from an inadequate number of skin donors, which in turn results from the current tissue donation system. Therefore, a proposal has been made for the organizational, legal and systemic changes required to improve the situation in Polish transplantology, with particular emphasis on skin donation. In order to achieve a strategic stock of human skin grafts, a tissue collecting transplantation team should be organized. The rights and obligations of the non-physician transplant team member should be extended. Proposals have been made for awareness campaigns (adverts, posters etc.) and educational schemes (educational video, lectures during transplant coordinator training, etc.). Finally, a proposal has been made for possible methods to deal with the logistic management of the allogeneic skin stock. The required, essential stock of human allogeneic skin in the event of a mass disaster has been estimated at 600,000 cm2.
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Affiliation(s)
- Wojciech Łabuś
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Diana Kitala
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | | | - Agnieszka Klama-Baryła
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Małgorzata Kraut
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Anna Sitkowska
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Wojciech Smętek
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
- Warsaw University of Technology, Warsaw, Poland
| | - Artur Kamiński
- Department of Transplantology and Central Tissue Bank, Medical University of Warsaw, Warsaw, Poland
- National Centre for Tissue and Cell Banking, Warsaw, Poland
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Nuclear burn as a fertility destroyer factor. Burns 2022; 48:2017-2019. [DOI: 10.1016/j.burns.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022]
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Lalkovicova M. Neuroprotective agents effective against radiation damage of central nervous system. Neural Regen Res 2022; 17:1885-1892. [PMID: 35142663 PMCID: PMC8848589 DOI: 10.4103/1673-5374.335137] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ionizing radiation caused by medical treatments, nuclear events or even space flights can irreversibly damage structure and function of brain cells. That can result in serious brain damage, with memory and behavior disorders, or even fatal oncologic or neurodegenerative illnesses. Currently used treatments and drugs are mostly targeting biochemical processes of cell apoptosis, radiation toxicity, neuroinflammation, and conditions such as cognitive-behavioral disturbances or others that result from the radiation insult. With most drugs, the side effects and potential toxicity are also to be considered. Therefore, many agents have not been approved for clinical use yet. In this review, we focus on the latest and most effective agents that have been used in animal and also in the human research, and clinical treatments. They could have the potential therapeutical use in cases of radiation damage of central nervous system, and also in prevention considering their radioprotecting effect of nervous tissue.
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Affiliation(s)
- Mária Lalkovicova
- Laboratory of Radiation Biology, Joint Institute for Nuclear Research, Dubna, Russia; Slovak Academy of Sciences, Institute of Experimental Physics, Košice, Slovakia
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Lebaron-Jacobs L, Herrera-Reyes E. Basic concepts of radiation emergency medicine. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S371-S390. [PMID: 34525459 DOI: 10.1088/1361-6498/ac270e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
Nuclear and radiological accidents are not frequent but may lead to major consequences in the population. For the health systems, the need to handle a large number of victims will probably remain as an exception. However, a high number of affected victims can be expected in some terrorist scenarios. In addition, medical accidents in radiotherapy, fluoroscopy and diagnostic radiology have increased the number of patients with severe radiation injuries considerably, especially in developed countries. Given the increased use of ionising radiation for industrial and medical purposes and new technological applications emerging, the number of accidents may increase in the future. Consequently, the early identification and adequate management of these emergencies is a priority, as well as the need for medical preparedness, requiring knowledge about various emergency scenarios and planning appropriate responses to them before they occur. Unfortunately, medical professionals have a substantial knowledge gap in identifying and treating injured persons affected by ionising radiation. As managing radiation accidents is a very challenging process, exercises must be carried out to organise a well-trained multidisciplinary group of professionals to manage any radiation accident properly. Efforts on a continuously updated guidance system should be developed. In addition, new approaches to foster sustainable interdisciplinary and international cooperative networks on radiation injuries are necessary. Lessons learned from past nuclear and radiological emergencies have significantly contributed to strengthening scientific knowledge and increasing the available medical information on the effects of ionising radiation in the human body. In this context, radiation emergency medicine has emerged as a discipline that contributes to the diagnosis, treatment, medical follow-up and prognosis of persons affected by radiation injuries in a nuclear or a radiological emergency. In this paper, we review some relevant concepts related to the medical preparedness and multidisciplinary response required to attend to persons affected by these emergencies.
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Affiliation(s)
- Laurence Lebaron-Jacobs
- Fundamental Research Division at the French Atomic Energy Commission (CEA), Cadarache, France
| | - Eduardo Herrera-Reyes
- Health Division at the Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
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Volinsky E, Lazmi-Hailu A, Cohen N, Adani B, Faroja M, Grunewald M, Gorodetsky R. Alleviation of acute radiation-induced bone marrow failure in mice with human fetal placental stromal cell therapy. Stem Cell Res Ther 2020; 11:337. [PMID: 32746939 PMCID: PMC7397607 DOI: 10.1186/s13287-020-01850-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/23/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Selected placental mesenchymal stromal cells isolated from the fetal mesenchymal placental tissues (f-hPSCs) were tested as cell therapy of lethal acute radiation syndrome (ARS) with bone marrow regeneration and induced extramedullary hematopoiesis. Methods and materials f-hPSCs were isolated from the chorionic plate of human placentae and further expanded in regular culture conditions. 2 × 106 f-hPSCs were injected on days 1 and 4 to 8-Gy total body irradiated (TBI) C3H mice, both intramuscularly and subcutaneously. Pre-splenectomized TBI mice were used to test the involvement of extramedullary spleen hematopoiesis in the f-hPSC-induced hematopoiesis recovery in the TBI mice. Weight and survival of the mice were followed up within the morbid period of up to 23 days following irradiation. The role of hematopoietic progenitors in the recovery of treated mice was evaluated by flow cytometry, blood cell counts, and assay of possibly relevant growth factors. Results and conclusions The survival rate of all groups of TBI f-hPSC-treated mice at the end of the follow-up was dramatically elevated from < 10% in untreated to ~ 80%, with a parallel regain of body weight, bone marrow (BM) recovery, and elevated circulating progenitors of blood cell lineages. Blood erythropoietin levels were elevated in all f-hPSC-treated mice. Extramedullary splenic hematopoiesis was recorded in the f-hPSC-treated mice, though splenectomized mice still had similar survival rate. Our findings suggest that the indirect f-hPSC life-saving therapy of ARS may also be applied for treating other conditions with a failure of the hematopoietic system and severe pancytopenia.
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Affiliation(s)
- Evgenia Volinsky
- Laboratory of Biotechnology and Radiobiology, Hadassah - Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.,IMRIC-Developmental Biology and Cancer Research, Hebrew University School of Medicine, P.O. Box 12271, 91121, Jerusalem, Israel
| | - Astar Lazmi-Hailu
- Laboratory of Biotechnology and Radiobiology, Hadassah - Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Nerel Cohen
- Laboratory of Biotechnology and Radiobiology, Hadassah - Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Boaz Adani
- Laboratory of Biotechnology and Radiobiology, Hadassah - Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Mohammad Faroja
- General Surgery, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Myriam Grunewald
- IMRIC-Developmental Biology and Cancer Research, Hebrew University School of Medicine, P.O. Box 12271, 91121, Jerusalem, Israel.
| | - Raphael Gorodetsky
- Laboratory of Biotechnology and Radiobiology, Hadassah - Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
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Farhood B, Ashrafizadeh M, Khodamoradi E, Hoseini-Ghahfarokhi M, Afrashi S, Musa AE, Najafi M. Targeting of cellular redox metabolism for mitigation of radiation injury. Life Sci 2020; 250:117570. [PMID: 32205088 DOI: 10.1016/j.lfs.2020.117570] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
Accidental exposure to ionizing radiation is a serious concern to human life. Studies on the mitigation of side effects following exposure to accidental radiation events are ongoing. Recent studies have shown that radiation can activate several signaling pathways, leading to changes in the metabolism of free radicals including reactive oxygen species (ROS) and nitric oxide (NO). Cellular and molecular mechanisms show that radiation can cause disruption of normal reduction/oxidation (redox) system. Mitochondria malfunction following exposure to radiation and mutations in mitochondria DNA (mtDNA) have a key role in chronic oxidative stress. Furthermore, exposure to radiation leads to infiltration of inflammatory cells such as macrophages, lymphocytes and mast cells, which are important sources of ROS and NO. These cells generate free radicals via upregulation of some pro-oxidant enzymes such as NADPH oxidases, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Epigenetic changes also have a key role in a similar way. Other mediators such as mammalian target of rapamycin (mTOR) and peroxisome proliferator-activated receptor (PPAR), which are involved in the normal metabolism of cells have also been shown to regulate cell death following exposure to radiation. These mechanisms are tissue specific. Inhibition or activation of each of these targets can be suggested for mitigation of radiation injury in a specific tissue. In the current paper, we review the cellular and molecular changes in the metabolism of cells and ROS/NO following exposure to radiation. Furthermore, the possible strategies for mitigation of radiation injury through modulation of cellular metabolism in irradiated organs will be discussed.
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Affiliation(s)
- Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Milad Ashrafizadeh
- Department of Basic Science, Veterinary Medicine Faculty, Tabriz University, Tabriz, Iran
| | - Ehsan Khodamoradi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mojtaba Hoseini-Ghahfarokhi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shima Afrashi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahmed Eleojo Musa
- Department of Medical Physics, Tehran University of Medical Sciences (International Campus), Tehran, Iran
| | - Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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