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Abdel-Haleem FM, Alhashemi Y, Rizk MS. PVC membrane bulk optode incorporating 4-nitrobenzo-15-crown-5 and sodium tetrakis(1-imidazolyl) borate for the pico-molar determination of silver ion in pharmaceutical formulation. Sci Rep 2024; 14:19984. [PMID: 39198688 PMCID: PMC11358330 DOI: 10.1038/s41598-024-70967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 08/22/2024] [Indexed: 09/01/2024] Open
Abstract
Silver ion (Ag+) is of harmful effects to both environment and human health. Ag+ soluble compounds and salts is used in treating mental illness, epilepsy, nicotine addiction, gastroenteritis, and infectious diseases, including syphilis and gonorrhea, and as anti-infective dermatological agent for controlling nose bleeding. However, high Ag+ doses cause several harmful effects to human health such as irreversible pigmentation of skin and eye, and problems to liver and kidney. A bulk membrane Optode is proposed in this work to measure the Ag+ concentration in the pharmaceutical formulations. The membrane optode is prepared from the ionophore 4-nitobenzo-15-crown-5, the ion-exchanger sodium tetrakis (imidazolyl) borate, the plasticizer o-nitrophenyl octyl ether, and the chromoionophore ETH 5294; these components are dissolved in the PVC/THF slurry to form the membrane. The optode is studied by atomic force microscope and UV-visible spectrophotometer, and its spectrum exhibits two maximum wavelengths of 550 and 665 nm, and response for Ag+ at these maximum wavelengths is reproducible in the concentration range of 10-11 to 10-8 M using acetate buffer of pH 5.0, with very low detection limit of 8.8 × 10-12 M. The most important feature in this work is the selectivity improvement for Ag+ over all interfering ions; the selectivity coefficient logarithmlogK A g + , c a t i o n opt is found to be - 4.3 for Cu2+, - 5.6 for Ni2+ and - 5.0 for Cd2+. The response mechanism is studied by FTIR, and it depends on ion-exchange of Ag+ and sodium imidazolyl borate, followed by the host-guest complexation between Ag+ and the crown ionophore, which is accompanied by concomitant deprotonation of the chromoionphore. The optode has a response time of 2-3 min within lifetime of 10 days with the same response. The optode can be applied successfully for Ag+ determination in the pharmaceutical formulation, PinkEye Relief® eye drop, which is used for treating inflammation, redness and water discharge of the eye; the high recovery and low standard deviation of the results using calibration curve method confirm the accuracy and precision of the proposed optode for its application in real samples.
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Affiliation(s)
- Fatehy M Abdel-Haleem
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11623, Riyadh, Saudi Arabia.
- Chemistry Department, Faculty of Science, Cairo University, Giza, Egypt.
| | - Yaser Alhashemi
- Chemistry Department, Faculty of Science, Cairo University, Giza, Egypt
- Ministry of Interior, Farwaniya, Kuwait
| | - Mahmoud S Rizk
- Chemistry Department, Faculty of Science, Cairo University, Giza, Egypt
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2
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Jiang Y, Zhang Q, Wang H, Välimäki M, Zhou Q, Dai W, Guo J. Effectiveness of silver and iodine dressings on wound healing: a systematic review and meta-analysis. BMJ Open 2024; 14:e077902. [PMID: 39142672 PMCID: PMC11331977 DOI: 10.1136/bmjopen-2023-077902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE To evaluate the effects of silver and iodine dressings on healing time, healing rate, exudate amount, pain and anti-infective efficacy. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Cochrane Library, Embase, Web of Science and CINAHL were surveyed up to May 2024. ELIGIBILITY CRITERIA Randomised controlled trials comparing silver and iodine dressings on wound healing in humans. DATA EXTRACTION AND SYNTHESIS Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data extraction was done independently by two reviewers, with the risk of bias assessed using the Cochrane tool. Narrative synthesis was performed to evaluate the effects of silver and iodine dressings on healing time, healing rate, pain, exudate amount and anti-infective efficacy. Meta-analysis using Review Manager V.5.4 calculated standardised mean differences for healing time and relative risks for rate to quantify the impacts of the treatments. RESULTS 17 studies (18 articles) were included. The meta-analysis indicated that silver dressings significantly reduced healing time compared with iodine dressings (SMD=-0.95, 95% CI -1.62 to -0.28, I2=92%, p=0.005, moderate-quality evidence), with no significant difference in enhancing healing rate (RR=1.29, 95% CI 0.90 to 1.85, I2=91%, p=0.16, low-quality evidence). Based on low-quality evidence, for exudate amount (3/17), 66.7% (2/3) of the studies favoured silver dressings over iodine in reducing exudate volume. For pain (7/17), 57.1% (4/7) of the studies reported no significant difference between silver and iodine dressings, while 42.9% (3/7) studies indicated superior pain relief with silver dressings. For anti-infective efficacy (11/13), 54.5% (6/11) of the studies showed equivalence between silver and iodine dressings, while 36.4% (4/11) suggested greater antibacterial efficacy for silver. CONCLUSION Silver dressings, demonstrating a comparable healing rate to iodine dressings, significantly reduce healing time, suggesting their potential as a superior adjunct in wound care. PROSPERO REGISTRATION NUMBER CRD42020199602.
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Affiliation(s)
- Yan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation: A JBI Center of Excellence, Changsha, China
| | - Qijian Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Hongjuan Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Maritta Välimäki
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation: A JBI Center of Excellence, Changsha, China
| | - Qiuhong Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Weiwei Dai
- Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation: A JBI Center of Excellence, Changsha, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation: A JBI Center of Excellence, Changsha, China
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3
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Jayram J, Kondaveeti SS, Gnanaraj Johnson C, Sampath PJ, Kalachaveedu M. Challenges and Prospects of Development of Herbal Biomaterial Based Ethical Wound Care Products-A Scoping Review. INT J LOW EXTR WOUND 2024; 23:291-305. [PMID: 34704490 DOI: 10.1177/15347346211052140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total wound care is an unmet therapeutic need considering the morbidity and mortality associated with the rising prevalence of nonhealing/chronic wounds. Current wound management fails to address all aspects/types of wounds despite the availability of scores of traditional and modern, investigational products. Traditional medicine drugs of wound healing repute validated to target multiple biological pathways and key events in the mammalian wound healing cascade, reportedly affecting wound healing phases. Advances in the development of biocomposite matrices and their analytical characterization warrant a relook at consolidating time-tested wound healing properties of herbal bioactives for prospective development as ethical wound care products. Aside from the bottlenecks of their multiconstituent profiling and clinical trial data generation, regulatory hurdles also cloister any systematic attempts at their re-engineering into clinical deliverables. In the context of national policy changes to bring in totally indigenous solutions, countries with a huge knowledge/material resource on wound healing bioactives need to essentially facilitate the same.
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Affiliation(s)
- Jayasutha Jayram
- Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | - Satish S Kondaveeti
- Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | | | - Preethi J Sampath
- Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | - Mangathayaru Kalachaveedu
- Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
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4
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Rodriguez-Arguello J, Lienhard K, De Grood J, Geransar R, Somayaji R, Khan D, Conly J, Ho C, Parsons L. The Use of Silver Oxynitrate Wound Dressings in the Treatment of Chronic Wounds: A Feasibility Pilot Study. Adv Skin Wound Care 2024; 37:197-202. [PMID: 38353651 DOI: 10.1097/asw.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of a silver oxynitrate (Ag 7 NO 11 ) dressing on wound healing in patients with stalled chronic wounds. METHODS A prospective pilot study was conducted to determine the feasibility and effect of using silver oxynitrate dressings within an outpatient setting in Alberta, Canada. A total of 23 patients (12 women and 11 men; mean age, 66.1 ± 13.8 years) with a chronic wound that failed to heal with conventional treatment were included in the study. Wound assessments including the Bates-Jensen Wound Assessment Tool, wound-related pain, wound size, and patient quality of life (QoL) were conducted at baseline, after dressing application for 1 and 2 weeks, and during 4- and 12-week follow-ups. RESULTS Dressing application at 1 and 2 weeks improved patients' wound healing progression as measured through significantly decreased Bates-Jensen Wound Assessment Tool scores with a more than 10% decrease at 4- and 12-week follow-up ( P < .001). Pain ( P = .004), and QoL psyche subscore ( P = .008) significantly improved at 4-week follow-ups, although wound area, perimeter, and QoL body and everyday subscores were not significantly affected. Wound size was not significantly affected. CONCLUSIONS The silver oxynitrate dressing may improve healing progression in patients with chronic wounds, enhance patient experience by reducing wound-related pain, and improve patients' mental well-being. Further studies are warranted to elucidate the effect of silver oxynitrate dressings on wound area, perimeter, and volume measurements.
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Affiliation(s)
- Jimena Rodriguez-Arguello
- At the Ward of the 21st Century (W21C) Research and Innovation Centre, Calgary, Alberta, Canada, Jimena Rodriguez-Arguello, BHSc, is Research Assistant; Karin Lienhard, PhD, CCRP, is Research Associate; and Rose Geransar, PhD, is Research Manager. Ranjani Somayaji, MD, is Assistant Professor, University of Calgary. John Conly, MD, is Medical Director, W21C Research and Innovation Centre and Infectious Disease Physician and Professor, Cumming School of Medicine, University of Calgary. Chester Ho, MD, is Professor and Division Director, Division of Physical Medicine and Rehabilitation, University of Alberta. Laurie Parsons, MD, is Dermatologist and Medical Director, Southern Alberta Sheldon Chumir Wound Clinic, and Clinical Associate Professor, University of Calgary
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5
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Jiang P, Li Q, Luo Y, Luo F, Che Q, Lu Z, Yang S, Yang Y, Chen X, Cai Y. Current status and progress in research on dressing management for diabetic foot ulcer. Front Endocrinol (Lausanne) 2023; 14:1221705. [PMID: 37664860 PMCID: PMC10470649 DOI: 10.3389/fendo.2023.1221705] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a major complication of diabetes and is associated with a high risk of lower limb amputation and mortality. During their lifetime, 19%-34% of patients with diabetes can develop DFU. It is estimated that 61% of DFU become infected and 15% of those with DFU require amputation. Furthermore, developing a DFU increases the risk of mortality by 50%-68% at 5 years, higher than some cancers. Current standard management of DFU includes surgical debridement, the use of topical dressings and wound decompression, vascular assessment, and glycemic control. Among these methods, local treatment with dressings builds a protective physical barrier, maintains a moist environment, and drains the exudate from DFU wounds. This review summarizes the development, pathophysiology, and healing mechanisms of DFU. The latest research progress and the main application of dressings in laboratory and clinical stage are also summarized. The dressings discussed in this review include traditional dressings (gauze, oil yarn, traditional Chinese medicine, and others), basic dressings (hydrogel, hydrocolloid, sponge, foam, film agents, and others), bacteriostatic dressings, composite dressings (collagen, nanomaterials, chitosan dressings, and others), bioactive dressings (scaffold dressings with stem cells, decellularized wound matrix, autologous platelet enrichment plasma, and others), and dressings that use modern technology (3D bioprinting, photothermal effects, bioelectric dressings, microneedle dressings, smart bandages, orthopedic prosthetics and regenerative medicine). The dressing management challenges and limitations are also summarized. The purpose of this review is to help readers understand the pathogenesis and healing mechanism of DFU, help physicians select dressings correctly, provide an updated overview of the potential of biomaterials and devices and their application in DFU management, and provide ideas for further exploration and development of dressings. Proper use of dressings can promote DFU healing, reduce the cost of treating DFU, and reduce patient pain.
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Affiliation(s)
- Pingnan Jiang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qianhang Li
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yanhong Luo
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Feng Luo
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qingya Che
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhaoyu Lu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shuxiang Yang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yan Yang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Endocrinology and Metabolism, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xia Chen
- Department of Endocrinology, Kweichow Moutai Hospital, Renhuai, Guizhou, China
| | - Yulan Cai
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Endocrinology and Metabolism, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Department of Endocrinology, Kweichow Moutai Hospital, Renhuai, Guizhou, China
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6
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Vishwanath N, Whitaker C, Allu S, Clippert D, Jouffroy E, Hong J, Stone B, Connolly W, Barrett CC, Antoci V, Born CT, Garcia DR. Silver as an Antibiotic-Independent Antimicrobial: Review of Current Formulations and Clinical Relevance. Surg Infect (Larchmt) 2022; 23:769-780. [PMID: 36178480 DOI: 10.1089/sur.2022.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The increase of multi-drug-resistant organisms has revived the use of silver as an alternative antibiotic-independent antimicrobial. Although silver's multimodal mechanism of action provides low risk for bacterial resistance, high local and uncontrolled concentrations have shown toxicity. This has resulted in efforts to develop novel silver formulations that are safer and more predictable in their application. Optimization of silver as an antimicrobial is crucial given the growing resistance profile against antibiotics. This article reviews formulations of silver used as antimicrobials, focusing on the mechanisms of action, potential for toxicity, and clinical applications. Methods: A search of four electronic databases (PubMed, Embase, MEDLINE, and Cochrane Library) was conducted for relevant studies up to January 2022. Searches were conducted for the following types of silver: ionic, nanoparticles, colloidal, silver nitrate, silver sulfadiazine, silver oxide, silver carboxylate, and AQUACEL® (ConvaTec, Berkshire, UK). Sources were compiled based on title and abstract and screened for inclusion based on relevance and study design. Results: A review of the antimicrobial activity and uses of ionic silver, silver nanoparticles, colloidal silver, silver nitrate, silver sulfadiazine, silver oxide, Aquacel, and silver carboxylate was conducted. The mechanisms of action, clinical uses, and potential for toxicity were studied, and general trends between earlier and more advanced formulations noted. Conclusions: Early forms of silver have more limited utility because of their uncontrolled release of silver ions and potential for systemic toxicity. Multiple new formulations show promise; however, there is a need for more prospective in vivo studies to validate the clinical potential of these formulations.
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Affiliation(s)
- Neel Vishwanath
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - Colin Whitaker
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Sai Allu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Drew Clippert
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - Elia Jouffroy
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - James Hong
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - Benjamin Stone
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - William Connolly
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Caitlin C Barrett
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - Valentin Antoci
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher T Born
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Dioscaris R Garcia
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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7
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Ongarora BG. Recent technological advances in the management of chronic wounds: A literature review. Health Sci Rep 2022; 5:e641. [PMID: 35601031 PMCID: PMC9117969 DOI: 10.1002/hsr2.641] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Wound treatment comprises a substantial portion of the healthcare budgets in developed countries. Studies suggest that about 50% of patients admitted to hospitals have wounds, while 1%−2% of the general population in the developed world suffers from chronic wounds. Chronic wounds fail to repair themselves within the expected period of 30 days. Technologies have been developed to address challenges encountered during wound care with the aim of alleviating pain, promoting healing, or controlling wound infections. Objective The objective of this study was to explore the technological improvements that have been made in this field over time. Methods To gain insight into the future of wound management, a systematic review of literature on the subject was conducted in scientific databases (PubMed, Scopus, Web of Science, Medline, and Clinical Trials). Results and Discussion Results indicate that wound dressings have evolved from the traditional cotton gauze to composite materials embedded with appropriate ingredients such as metal‐based nanoparticles. Studies on biodegradable dressing materials are also underway to explore their applicability in dressing large and irregular wounds. On the other hand, conventional drugs and traditional formulations for the management of pain, inflammation, infections, and accelerating healing have been developed. However, more research needs to be carried out to address the issue of microbial resistance to drugs. Drugs for managing other ailments also need to be designed in such a way that they can augment wound healing. In addition, it has been demonstrated that a coordinated integration of conventional and traditional medicine can produce laudable results in chronic wound management. Conclusion Accordingly, collaborative efforts and ingenuity of all players in the field can accelerate technological advances in the wound care market to the benefit of the patients. Wounds affect about 50% of patients admitted to hospitals.
Technologies have been developed including biodegradable dressing materials to address underlying challenges.
Technological advancement, rising incidences of chronic wounds, growing government support, and a rising elderly population will drive wound market growth.
A careful combination of recent research outputs can greatly change wound care technologies.
This review highlights the recent research advances and opportunities in the wound care field.
The future lies in biodegradable dressing materials, probably embedded with selected nanoparticles and which shall be combined in predetermined ratios.
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Affiliation(s)
- Benson G. Ongarora
- Department of Chemistry Dedan Kimathi University of Technology Nyeri Kenya
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8
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Janowska A, Davini G, Iannone M, Fidanzi C, Morganti R, Romanelli M, Dini V. The Role of Autoflorescence Imaging Device in the Evaluation of Bacteria Burden Control. INT J LOW EXTR WOUND 2022:15347346221098514. [PMID: 35538896 DOI: 10.1177/15347346221098514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
MolecuLight i:X is a autofluorescence, portable device that allows an assessment of wound area, perimeter, width and length and an evaluation in real time of wound surface bacteria (>104 CFU/g). Primary objective of our study was to evaluate the reduction of bacterial load associated to 3 different therapeutic approaches: dressings and multicomponent bandages (Group1), sharp debridement, dressings and multicomponent bandages (Group 2), and 10 patients treated with zinc oxide bandage (Group 3). Secondary objective was NRS pain scale, Wound Bed Score (WBS) and Quality of Life (QoL) assessment. Despite the improvement of bacterial load, WBS, Qol and NRS was evident in all 3 groups, the analysis of our results demonstrates that the application of zinc oxide bandage, directly in contact with the wound bed and/or the perilesional skin, resulted in a higher improvement and a significant reduction of WBS and bacterial load. Fluorescence imaging can help the specialist in a more targeted assessment and management of infection. Sharp debridement and antiseptic dressings are classically used to reduced bacteria burden. Zinc oxide directly on the wound is an interesting cost-effective option to control different types of bacteria.
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Affiliation(s)
- Agata Janowska
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Giulia Davini
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Michela Iannone
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | | | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistic, 9310University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
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9
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Egan G, Phuagkhaopong S, Matthew SAL, Connolly P, Seib FP. Impact of silk hydrogel secondary structure on hydrogel formation, silk leaching and in vitro response. Sci Rep 2022; 12:3729. [PMID: 35260610 PMCID: PMC8904773 DOI: 10.1038/s41598-022-07437-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/15/2022] [Indexed: 11/09/2022] Open
Abstract
Silk can be processed into a broad spectrum of material formats and is explored for a wide range of medical applications, including hydrogels for wound care. The current paradigm is that solution-stable silk fibroin in the hydrogels is responsible for their therapeutic response in wound healing. Here, we generated physically cross-linked silk fibroin hydrogels with tuned secondary structure and examined their ability to influence their biological response by leaching silk fibroin. Significantly more silk fibroin leached from hydrogels with an amorphous silk fibroin structure than with a beta sheet-rich silk fibroin structure, although all hydrogels leached silk fibroin. The leached silk was biologically active, as it induced vitro chemokinesis and faster scratch assay wound healing by activating receptor tyrosine kinases. Overall, these effects are desirable for wound management and show the promise of silk fibroin and hydrogel leaching in the wider healthcare setting.
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Affiliation(s)
- Gemma Egan
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, UK.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - Suttinee Phuagkhaopong
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - Saphia A L Matthew
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - Patricia Connolly
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, UK.
| | - F Philipp Seib
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK. .,EPSRC Future Manufacturing Research Hub for Continuous Manufacturing and Advanced Crystallisation (CMAC), University of Strathclyde, Technology and Innovation Centre, 99 George Street, Glasgow, G1 1RD, UK.
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10
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Ju Q, Zenji T, Maçon ALB, Norris E, Poologasundarampillai G, Obata A, Jones JR, Kasuga T. Silver-doped calcium silicate sol-gel glasses with a cotton-wool-like structure for wound healing. BIOMATERIALS ADVANCES 2022; 134:112561. [PMID: 35523641 DOI: 10.1016/j.msec.2021.112561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 06/14/2023]
Abstract
Skin has excellent capacity to regenerate, however, in the event of a large injury or burn skin grafts are required to aid wound healing. The regenerative capacity further declines with increasing age and can be further exacerbated with bacterial infection leading to a chronic wound. Engineered skin substitutes can be used to provide a temporary template for the damaged tissue, to prevent/combat bacterial infection and promote healing. In this study, the sol-gel process and electrospinning were combined to fabricate 3D cotton-wool-like sol-gel bioactive glass fibers that mimic the fibrous architecture of skin extracellular matrix (ECM) and deliver metal ions for antibacterial (silver) and therapeutic (calcium and silica species) actions for successful healing of wounds. This study investigated the effects of synthesis and process parameters, in particular sintering temperature on the fiber morphology, the incorporation and distribution of silver and the degradation rate of fibers. Silver nitrate was found to decompose into silver nanoparticles within the glass fibers upon calcination. Furthermore, with increasing calcination temperature the nanoparticles increased in size from 3 nm at 600 °C to ~25 nm at 800 °C. The antibacterial ability of the Ag-doped glass fibers decreased as a function of the glass calcination temperature. The degradation products from the Ag-doped 3D non-woven sol-gel glass fibers were also found to promote fibroblast proliferation thus demonstrating their potential for use in skin regeneration.
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Affiliation(s)
- Qun Ju
- Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
| | - Takuya Zenji
- Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
| | - Anthony L B Maçon
- Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
| | - Elizabeth Norris
- Department of Materials, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Gowsihan Poologasundarampillai
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, 5 Mil Pool Way, Edgbaston, Birmingham B5 7EG, UK
| | - Akiko Obata
- Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan.
| | - Julian R Jones
- Department of Materials, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Toshihiro Kasuga
- Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
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11
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Rosyidah A, Weeranantanapan O, Chudapongse N, Limphirat W, Nantapong N. Streptomyces chiangmaiensis SSUT88A mediated green synthesis of silver nanoparticles: characterization and evaluation of antibacterial action against clinical drug-resistant strains. RSC Adv 2022; 12:4336-4345. [PMID: 35425449 PMCID: PMC8981172 DOI: 10.1039/d1ra08238h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/22/2022] [Indexed: 01/28/2023] Open
Abstract
This study involved the characterization of AgNPs synthesized from soil isolate Streptomyces sp. SSUT88A and their antimicrobial activities. The strain SSUT88A revealed 98.8% similarity of the 16s rRNA gene to Streptomyces chiangmaiensis TA4-1T. The AgNPs were synthesized by mixing either intracellular or extracellular cell-free supernatant of strain SSUT88A with AgNO3. The synthesized AgNPs from intracellular cell-free supernatant and extracellular cell-free supernatant were designated as IS-AgNPs and ES-AgNPs, respectively. The IS-AgNPs showed maximum absorbance of UV-vis spectra at 418 nm, while ES-AgNPs revealed maximum absorbance at 422 nm. The TEM observation of synthesized AgNPs revealed a spherical shape with an average diameter of 13.57 nm for IS-AgNPs and 30.47 nm for ES-AgNPs. The XRD and XANES spectrum profile of both synthesized AgNPs exhibited similar spectrum energy, which corresponded to AgNPs. The IS-AgNPs revealed antimicrobial activity against clinical isolate drug-resistant bacteria (Acinetobacter baumannii, Escherichia coli 8465, Klebsiella pneumoniae 1617, and Pseudomonas aeruginosa N90PS), while ES-AgNPs had no antimicrobial activity. When compared to commercial AgNPs, IS-AgNPs exhibited antibacterial efficacy against all clinical isolate bacteria including A. baumannii, one of the most threatening multi-drug resistant strains, while commercial AgNPs did not. Thus, IS-AgNPs has potential to be further developed as an antimicrobial agent against drug-resistant bacteria.
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Affiliation(s)
- A'liyatur Rosyidah
- School of Preclinical Sciences, Institute of Science, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
- Research Center for Biology, National Research and Innovation Agency (BRIN) West Java 16911 Indonesia
| | - Oratai Weeranantanapan
- School of Preclinical Sciences, Institute of Science, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
- Center of Excellence on Advanced Functional Materials, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
| | - Nuannoi Chudapongse
- School of Preclinical Sciences, Institute of Science, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
- Center of Excellence on Advanced Functional Materials, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
| | - Wanwisa Limphirat
- Synchrotron Light Research Institute (SLRI) Nakhon Ratchasima 30000 Thailand
| | - Nawarat Nantapong
- School of Preclinical Sciences, Institute of Science, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
- Center of Excellence on Advanced Functional Materials, Suranaree University of Technology Nakhon Ratchasima 30000 Thailand
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12
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Nuutila K, Eriksson E. Moist Wound Healing with Commonly Available Dressings. Adv Wound Care (New Rochelle) 2021; 10:685-698. [PMID: 32870777 DOI: 10.1089/wound.2020.1232] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Significance: A moist wound environment has several benefits that result in faster and better quality of healing. It facilitates autolytic debridement, reduces pain, reduces scarring, activates collagen synthesis, facilitates and promotes keratinocyte migration over the wound surface, and supports the presence and function of nutrients, growth factors, and other soluble mediators in the wound microenvironment. Recent Advances: Wound dressings can be utilized to create, maintain, and control a moist environment for healing. Moist wound dressings can be divided into films, foams, hydrocolloids, hydrogels, and alginates. We are also including negative pressure wound therapy systems in the moist dressings. Critical Issues: An optimal wound dressing should provide a moist environment and have an optimal water vapor transmission rate (WVTR) and absorptive capacity. It should also protect the wound against trauma and contamination and be easy to apply, painless to remove, and esthetically acceptable or even pleasing. Future Directions: Interventions, particularly dressing changes, by medical caregivers are labor intensive and expensive and there should be a continuous effort to reduce their number per week. Smart dressings with integrated microsensors and delivery capabilities that would allow wireless real-time monitoring and treatment of the wound would be very advantageous. This way the state of the wound as well as the wear time of the dressing could be assessed without dressing removal or visit to the wound care center. In addition, an ability to adjust the WVTRs to the exudate level of the wound (or having a large absorptive capacity without changing the WVTR) would be useful. This feature would guarantee an optimal level of hydration of the wound surface throughout the treatment.
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Affiliation(s)
- Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elof Eriksson
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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13
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A Comprehensive Review of the Pathogenesis, Diagnosis, and Management of Diabetic Foot Infections. Adv Skin Wound Care 2021; 34:574-581. [PMID: 34669660 DOI: 10.1097/01.asw.0000791876.10485.d4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
GENERAL PURPOSE To review an approach to diabetic foot infections (DFIs), including acute osteomyelitis, while also discussing current practices and the challenges in diagnosis and management. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will1. Identify the risk factors for developing DFIs.2. Outline diagnostic techniques for assessing DFIs.3. Select the assessment techniques that support a diagnosis of osteomyelitis.4. Choose the appropriate pharmacologic and nonpharmacologic treatment options for patients who have DFIs. ABSTRACT Diabetic foot ulcers result from a combination of peripheral neuropathy, vascular compromise, and repetitive trauma. Approximately 50% of individuals with diabetic foot ulcers will develop a diabetic foot infection (DFI), and 20% of individuals with a DFI will develop osteomyelitis. Herein, the authors review an approach to DFIs including acute osteomyelitis and discuss current practices and challenges in diagnosis and management.The diagnosis of a skin and soft tissue DFI is based on clinical criteria. A bone biopsy is considered the criterion standard for diagnosis of osteomyelitis; however, biopsy is not always feasible or available. Consequently, diagnosis can be made using a combination of clinical, biochemical, and radiographic findings. X-ray is the recommended imaging modality for initial evaluation; however, because of its lower relative sensitivity, advanced imaging may be used when clinical suspicion remains after negative initial testing.The microbiology of skin and soft tissue DFIs and osteomyelitis is similar. Staphylococcus aureus and other Gram-positive cocci are the most common pathogens identified. Deep cultures are preferred in both DFI and osteomyelitis to identify the etiologic pathogens implicated for targeted antimicrobial therapy. Management also requires a multidisciplinary approach. Surgical debridement in those with deep or severe infections is necessary, and surgical resection of infected bone is curative in cases of osteomyelitis. Finally, appropriate wound care is critical, and management of predisposing factors, such as peripheral neuropathy, peripheral arterial disease, tinea, and edema, aids in recovery and prevention.
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14
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The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing. J Clin Med 2021; 10:jcm10071495. [PMID: 33916790 PMCID: PMC8038333 DOI: 10.3390/jcm10071495] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023] Open
Abstract
Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.
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15
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Bonete JÉM, Silva GD, Guidelli ÉJ, GonÇalves PJ, Almeida LM, Baffa O, Kinoshita A. Tissue reaction and anti-biofilm action of new biomaterial composed of latex from Hancornia speciosa Gomes and silver nanoparticles. AN ACAD BRAS CIENC 2020; 92:e20191584. [PMID: 33206788 DOI: 10.1590/0001-3765202020191584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
In this work, the natural latex extracted from Harconia speciosa was incorporated with silver nanoparticles (AgNP) to compose a functional biomaterial associating the intrinsic angiogenic activity of the latex and the antimicrobial activity of AgNP. Tissue reaction after subcutaneous implantation in dorsum of rats of membranes without AgNP and with 0.05%, 0.4% AgNP was compared at 3, 7 and 25 days. No statistically significant difference in the tissue response of the different biomaterials was observed, indicating that AgNP did not interfere with the inflammatory reaction (p > 0.05) or with the angiogenic activity of latex. Biomembranes were also tested against bacterial biofilm formation by Staphylococcus aureus and the antimicrobial activity of the new biomaterial can be found with bacteria crenation (0.05% AgNP) and no biofilm deposition (0.4% AgNP). Therefore, this biomaterial has interesting properties for the tissue repair process and may be feasible for future applications as dressing.
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Affiliation(s)
- JÉssica M Bonete
- PRPPG, Universidade do Sagrado Coração/USC, Rua Irmã Arminda, 10-50, Bauru, 17011-160 SP, Brazil
| | - Guilherme D Silva
- PRPPG, Universidade do Sagrado Coração/USC, Rua Irmã Arminda, 10-50, Bauru, 17011-160 SP, Brazil
| | - Éder J Guidelli
- Universidade de São Paulo/FFCLRP, Departamento de Física, Av. Bandeirantes, 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Pablo J GonÇalves
- Universidade Federal de Goiás/UFG, Instituto Física, Av. Esperança, s/n, Campus Samambaia, 14049-900 Goiânia, GO, Brazil
| | - Luciane M Almeida
- Universidade Estadual de Goiás/UEG, BR-153 3105, Fazenda Barreiro do Meio, Campus Anápolis de Ciências Exatas e Tecnológicas, 75132-400 Anápolis, GO, Brazil
| | - Oswaldo Baffa
- Universidade de São Paulo/FFCLRP, Departamento de Física, Av. Bandeirantes, 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Angela Kinoshita
- PPGMADRE, Universidade do Oeste Paulista/UNOESTE, SP-270, Km 572, 19067-175 Presidente Prudente, SP, Brazil.,Curso de Odontologia, Faculdade do Centro Oeste Paulista/FACOP, Rua Luiz Gimenez Mocegose, 72, Distrito Industrial, 17490-000 Piratininga, SP, Brazil
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16
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The Effects of Silver Sulfadiazine on Methicillin-Resistant Staphylococcus aureus Biofilms. Microorganisms 2020; 8:microorganisms8101551. [PMID: 33050001 PMCID: PMC7600712 DOI: 10.3390/microorganisms8101551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA), the most commonly detected drug-resistant microbe in hospitals, adheres to substrates and forms biofilms that are resistant to immunological responses and antimicrobial drugs. Currently, there is a need to develop alternative approaches for treating infections caused by biofilms to prevent delays in wound healing. Silver has long been used as a disinfectant, which is non-specific and has relatively low cytotoxicity. Silver sulfadiazine (SSD) is a chemical complex clinically used for the prevention of wound infections after injury. However, its effects on biofilms are still unclear. In this study, we aimed to analyze the mechanisms underlying SSD action on biofilms formed by MRSA. The antibacterial effects of SSD were a result of silver ions and not sulfadiazine. Ionized silver from SSD in culture media was lower than that from silver nitrate; however, SSD, rather than silver nitrate, eradicated mature biofilms by bacterial killing. In SSD, sulfadiazine selectively bound to biofilms, and silver ions were then liberated. Consequently, the addition of an ion-chelator reduced the bactericidal effects of SSD on biofilms. These results indicate that SSD is an effective compound for the eradication of biofilms; thus, SSD should be used for the removal of biofilms formed on wounds.
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17
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Thymoquinone-Loaded Polymeric Films and Hydrogels for Bacterial Disinfection and Wound Healing. Biomedicines 2020; 8:biomedicines8100386. [PMID: 32998437 PMCID: PMC7600314 DOI: 10.3390/biomedicines8100386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to synthesize and characterize novel biocompatible topical polymeric film and hydrogel systems that have the potential to deliver the antibacterial agent thymoquinone (TQ) directly to the skin target site to manage the local wound infection and thereby wound healing. The polyvinyl pyrrolidone (PVP) matrix-type films containing TQ were prepared by the solvent casting method. In vitro skin permeation studies on human cadaver skin produced a mean flux of 2.3 µg TQ/cm2/h. Human keratinocyte monolayers subjected to a scratch wound (an in vitro wound healing assay) showed 85% wound closure at day 6 in the TQ group (100 ng/mL TQ) as compared to 50% in the vehicle control group (p = 0.0001). In a zone-of-inhibition (ZOI) assay, TQ-containing films and hydrogels completely wiped out Staphylococcus aureus in 10 cm diameter Tryptic Soy Agar plates while 500 µg/mL gentamicin containing filters gave 10 mm of ZOI. In an ex vivo model, TQ-containing films eradicated bacterial colonization on human cadaver skin. Furthermore, in a full-thickness wound infection model in mice, TQ-containing films showed significant activity in controlling Staphylococcus aureus infection, thereby disinfecting the skin wound. In summary, TQ-containing PVP films and hydrogels developed in this study have the potential to treat and manage wound infections.
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18
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Talapko J, Matijević T, Juzbašić M, Antolović-Požgain A, Škrlec I. Antibacterial Activity of Silver and Its Application in Dentistry, Cardiology and Dermatology. Microorganisms 2020; 8:E1400. [PMID: 32932967 PMCID: PMC7565656 DOI: 10.3390/microorganisms8091400] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
The problem of antimicrobial resistance is increasingly present and requires the discovery of new antimicrobial agents. Although the healing features of silver have been recognized since ancient times, silver has not been used due to newly discovered antibiotics. Thanks to technology development, a significant step forward has been made in silver nanoparticles research. Nowadays, silver nanoparticles are a frequent target of researchers to find new and better drugs. Namely, there is a need for silver nanoparticles as alternative antibacterial nanobiotics. Silver nanoparticles (AgNPs), depending on their size and shape, also have different antimicrobial activity. In addition to their apparent antibacterial activity, AgNPs can serve as drug delivery systems and have anti-thrombogenic, anti-platelet, and anti-hypertensive properties. Today they are increasingly used in clinical medicine and dental medicine. This paper presents silver antimicrobial activity and its use in dentistry, cardiology, and dermatology, where it has an extensive range of effects.
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Affiliation(s)
- Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
| | - Tatjana Matijević
- Department of Dermatology and Venereology, Clinical Hospital Center Osijek, HR-31000 Osijek, Croatia;
| | - Martina Juzbašić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
| | - Arlen Antolović-Požgain
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
- Department of Microbiology, Institute of Public Health Osijek, HR-31000 Osijek, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
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19
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Zhao M, Zhang D, Tan L, Huang H. Silver dressings for the healing of venous leg ulcer: A meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e22164. [PMID: 32925780 PMCID: PMC7489700 DOI: 10.1097/md.0000000000022164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study was aimed to evaluate whether silver-containing dressings were superior to other types of dressings in the treatment of venous leg ulcers (VLU) and their specific advantages.Eight databases (Cochrane Library, PubMed, Web of Science, Ovid-Medline, Wanfang, VIP, China Biology Medicine, and China National Knowledge Infrastructure) were systematically reviewed from inception to May 2019 for randomized controlled trials (RCTs). The primary outcome was complete wound healing, and the secondary outcomes included absolute wound size changes (change of cm area since baseline), relative changes (percentage change of area relative to baseline), and healing rate. Two reviewers independently evaluated the risk of bias using the Cochrane Collaboration assessment tool and extracted the data according to the predesigned table. All analyses were performed using the latest Review Manager Software (version 5.3).A total of 8 studies qualified and were included in the meta-analysis, including 1057 patients (experiment: 526, control: 531). Both complete wound healing and wound healing rates were reported in 5 studies. Two and 3 studies reported the effect of silver dressings on absolute and relative wound size changes, respectively. Most of the studies used intention-to-treat analysis.There was sufficient evidence that silver-containing dressings can accelerate the healing rate of chronic VLU and improve their healing in a short duration of time. However, compared with other dressings, clinical trials with long-term follow-up data are needed to confirm whether silver dressings have advantages regarding complete wound healing.
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Affiliation(s)
- Minyan Zhao
- Department of Oncology, The Second Affiliated Hospital of Soochow University
| | | | - Liping Tan
- Department of Nursing, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Huang
- Department of Nursing, The Second Affiliated Hospital of Soochow University, Suzhou, China
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20
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Pang S, Gao Y, Wang F, Wang Y, Cao M, Zhang W, Liang Y, Song M, Jiang G. Toxicity of silver nanoparticles on wound healing: A case study of zebrafish fin regeneration model. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 717:137178. [PMID: 32062274 DOI: 10.1016/j.scitotenv.2020.137178] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
Dressings coated with silver nanoparticle (AgNP) are widely used in the management of acute and chronic wounds. However, whether AgNP exerts toxicity on wound healing remains ambiguous. To demonstrate the effects of AgNP on wound healing, we precisely quantified the recovery speed of wound by taking advantage of the fin regeneration of zebrafish. This method also enabled assessment of the adverse effect of AgNP on various steps of wound healing in vivo. We revealed that AgNP treatment at the concentration of 2 μg/ml impaired fin regeneration when exposure was performed at the phases of epithelialization and the beginning of blastema formation. Cell proliferation of regenerative blastema was significantly decreased after AgNP exposure. But the canonical signals including Wingless/Integrated (Wnt), Notch and Fibroblast growth factor (Fgf) which play important roles in cell proliferation during fin regeneration were not modulated at 36 hours post amputation (hpa). Further study showed that AgNP impaired fin regeneration through declining amputation-induced ROS as early as epithelialized phase at 18 hpa, rather than inducing ROS generation. AgNP exposure also promoted recruitment of neutrophils in the early phase of wound healing, which suggests that this event dampened amputation-induced ROS. Overall, this study suggested that application of AgNP-coated dressings should be carefully considered at the beginning stage of wound healing.
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Affiliation(s)
- Shaochen Pang
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, Jianghan University, Wuhan 430056, China; Key Laboratory of Environmental Nanotechnology and Health Effects, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Yue Gao
- Key Laboratory of Environmental Nanotechnology and Health Effects, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fengbang Wang
- Key Laboratory of Environmental Nanotechnology and Health Effects, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yuanyuan Wang
- Key Laboratory of Environmental Nanotechnology and Health Effects, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Mengxi Cao
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, Jianghan University, Wuhan 430056, China; Institute of Environment and Health, Jianghan University, Wuhan 430056, China
| | - Wenjuan Zhang
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, Jianghan University, Wuhan 430056, China; Key Laboratory of Environmental Nanotechnology and Health Effects, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; Institute of Environment and Health, Jianghan University, Wuhan 430056, China
| | - Yong Liang
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, Jianghan University, Wuhan 430056, China; Institute of Environment and Health, Jianghan University, Wuhan 430056, China
| | - Maoyong Song
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, Jianghan University, Wuhan 430056, China; Key Laboratory of Environmental Nanotechnology and Health Effects, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Guibin Jiang
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, Jianghan University, Wuhan 430056, China; Institute of Environment and Health, Jianghan University, Wuhan 430056, China; University of Chinese Academy of Sciences, Beijing 100049, China
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21
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Duckworth PF, Maddocks SE, Rahatekar SS, Barbour ME. Alginate films augmented with chlorhexidine hexametaphosphate particles provide sustained antimicrobial properties for application in wound care. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:33. [PMID: 32162052 PMCID: PMC7066275 DOI: 10.1007/s10856-020-06370-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
All chronic wounds are colonised by bacteria; for some, colonisation progresses to become infection. Alginate wound dressings are used for highly exuding chronic wounds as they are very absorbent, taking up large quantities of exudate while maintaining a moist wound bed to support healing. Some alginate dressings are doped with antimicrobials, most commonly silver, but evidence regarding the efficacy of these is largely inconclusive. This manuscript describes the development and in vitro assessment of alginate materials doped with chlorhexidine hexametaphosphate (CHX-HMP), a sparingly soluble salt which when exposed to aqueous environments provides sustained release of the common antiseptic chlorhexidine. Comparator materials were a commercial silver alginate dressing material and an alginate doped with chlorhexidine digluconate (CHXdg). CHX-HMP alginates provided a dose-dependent CHX release which was sustained for over 14 days, whereas CHXdg alginates released limited CHX and this ceased within 24 h. CHX-HMP and silver alginates were efficacious against 5 major wound pathogens (MRSA, E. coli, P. aeruginosa, K. pneumoniae, A. baumannii) in a total viable count (TVC) and an agar diffusion zone of inhibition (ZOI) model. At baseline the silver alginate was more effective than the CHX-HMP alginate in the TVC assay but the CHX-HMP alginate was the more effective in the ZOI assay. After 7 days' artificial aging the CHX-HMP alginate was more effective than the silver alginate for four of the five bacteria tested in both assays. These materials may ultimately find application in the development of wound dressings for chronic wounds that provide sustained antimicrobial protection.
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Affiliation(s)
- Peter F Duckworth
- Oral Nanoscience, Bristol Dental School, University of Bristol, Bristol, UK
- ACCIS, Queens School of Engineering, University of Bristol, Bristol, UK
| | - Sarah E Maddocks
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Sameer S Rahatekar
- School of Aerospace, Transport and Manufacturing, University of Cranfield, Bedford, UK
| | - Michele E Barbour
- Oral Nanoscience, Bristol Dental School, University of Bristol, Bristol, UK.
- Pertinax Pharma Ltd, Bristol, UK.
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22
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Abstract
Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.
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Affiliation(s)
- André Oliveira
- Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - Sandra Simões
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Ascenso
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Pinto Reis
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal.,Faculty of Sciences, Biophysics and Biomedical Engineering, IBEB, Universidade de Lisboa, Lisboa, Portugal
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Salatin S, Lotfipour F, Jelvehgari M. A brief overview on nano-sized materials used in the topical treatment of skin and soft tissue bacterial infections. Expert Opin Drug Deliv 2019; 16:1313-1331. [PMID: 31738622 DOI: 10.1080/17425247.2020.1693998] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Skin and soft tissue infections are a significant clinical problem that can happen anywhere on the body. Bacteria are the most common cause of skin and soft tissue infections in humans. Despite the fact that there is a lot of antimicrobial agents and antibiotics for elucidating bacterial infections, the prevention and control of infectious diseases continue to be one of the greatest challenges for public health worldwide. At the present time, an alarming increase in multidrug resistance instantly requests to find suitable alternatives to current antibiotics. Therefore, drug resistance has been attempted to be resolved by the development of new classes of antimicrobial agents or targeted delivery systems for antibacterial drugs using nanotechnology.Area covered: The present review summarizes the emerging topical efforts to support the use of nano-sized materials as a new opportunity to combat today's skin infectious diseases.Expert opinion: Nano-sized materials can overcome the stratum corneum barrier and deliver drugs specifically to bacterial skin infections with trivial side effects. Depending on the physicochemical characteristics of nano-scaled materials, they can specifically be selected to target bacterial pathogens and also to get into the skin layers. These systems can overcome the antibiotic-resistance mechanisms and help us to the design of novel topical formulations that will make administration of antibacterial compounds safer, easier and more convenient.
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Affiliation(s)
- Sara Salatin
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzaneh Lotfipour
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Pharmaceutical and Food Control, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mitra Jelvehgari
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Pomponio G, Tedesco S, Peghetti A, Bianchi T, Rowan S, Greco A, Cutting K, Price P, Moore Z, Gabrielli A, Wolcott R. Improving the quality of clinical research on chronic wound infection treatment: expert-based recommendations. J Wound Care 2019; 28:S26-S31. [PMID: 30724117 DOI: 10.12968/jowc.2019.28.sup1.s26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE: To produce recommendations for the design of reliable and informative clinical investigations in chronic wound infection. METHOD: A multidisciplinary panel of international experts from four countries (Italy, UK, Ireland and the US) were involved in a detailed, semi-structured discussion on how to better select and describe a target population, interventions and outcomes, and which infection-related criteria to apply in order to achieve a high-quality trial. Consent among the experts was measured using the Delphi method and GRADE Working Group suggestions. The project was fully supported by AISLeC 2016 (Italian Nursing Society for Wound Care Study). RESULTS: In total, 37 recommendations achieved substantial agreement among the experts; 10 concerned the most appropriate description and selection of a target population, four related to interventions and 15 to outcomes. A further eight statements about critical methodological points were approved. CONCLUSION: Developing recommendations in a systematic manner through a representative group of experts could generate tools for improving the design of clinical trials in this challenging area.
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Affiliation(s)
| | - Silvia Tedesco
- SOSD Fibrosi Cistica, AOU Ospedali Riuniti di Ancona, Italy
| | - Angela Peghetti
- Ospedale S. Orsola-Malpighi, Bologna, former AISLeC President, Executive Board of World Union of Wound Healing Societies, Italy
| | - Tommaso Bianchi
- UO Dermatologia AUSL Bologna - Istituto delle scienze neurologiche Bellaria, Bologna, Italy
| | - Sara Rowan
- C3S - Clinical Scientific Support Services, Italy
| | - Alessandro Greco
- Outpatient Wound Care Centre, Local Health Care System Frosinone, Italy
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Tissue Viability Specialist, First Community Health and Care, Surrey, UK
| | - Patricia Price
- Emeritus Professor; c/o Pro Vice-Chancellors' Office, Cardiff University, UK
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland; and Visiting Professor, Department of Public Health, Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium
| | - Armando Gabrielli
- Professor; Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
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25
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Wu X, Liu R, Lao TT. Therapeutic compression materials and wound dressings for chronic venous insufficiency: A comprehensive review. J Biomed Mater Res B Appl Biomater 2019; 108:892-909. [PMID: 31339655 DOI: 10.1002/jbm.b.34443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/06/2019] [Accepted: 06/28/2019] [Indexed: 01/15/2023]
Abstract
Chronic venous insufficiency (CVI) is a common disorder worldwide. Related pathophysiological mechanisms reportedly involve venous pooling and reduced venous return, leading to heaviness, aching, itchiness, tiredness, varicosities, pigmentation, and even lower limb ulceration. Approaches adopted to manage CVI at various stages of clinical-etiology-anatomy-pathophysiology include compression therapy, pharmacological treatment, ultrasound treatment, surgery, electrical or wireless microcurrent stimulation, and pulsed electromagnetic treatment. Among these, polymer-based therapeutic compression materials and wound dressings play increasingly key roles in treating all stages of CVI because of their unique physical, mechanical, chemical, and biological functions. However, the characteristics, working mechanisms, and effectiveness of these CVI treatment materials are not comprehensively understood. The present systematic review examines the structures, properties, types, and applications of various polymer-based compression materials and wound dressings used in prophylaxis and treatment of CVI. Existing problems, limitations, and future trends of CVI treatment materials are also discussed. This review could contribute to the design and application of new functional polymer materials and dressings to enhance the efficiency of CVI treatments, thereby facilitating patients' self-care ability and long-term health improvement.
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Affiliation(s)
- Xinbo Wu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Rong Liu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Terence T Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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27
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Zhang X, Sun D, Jiang GC. Comparative efficacy of nine different dressings in healing diabetic foot ulcer: A Bayesian network analysis. J Diabetes 2019; 11:418-426. [PMID: 30324760 DOI: 10.1111/1753-0407.12871] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a wide variety of dressings currently available for the treatment of diabetic foot ulcers (DFUs). Because of a lack of evidence from head-to-head randomized controlled trials (RCTs), the relative effects of these dressings in DFU patients remain unclear. This study compared the efficacy of nine dressings in healing DFU. METHODS A literature search was performed of the MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Reports published from 1993 to 2017 focusing on dressings for healing DFU were identified. RESULTS Twenty-one RCTs, with a total of 2159 patients, were included in the present study. Bayesian network analysis showed that amniotic membrane dressings were superior to alginate, basic wound contact, foam, honey-impregnated, hydrocolloid, and iodine-impregnated dressings. Hydrogel dressings were better than basic wound contact dressings. Other dressings showed no significant differences. According to the probability of ranking results, amniotic membrane and hydrogel dressings are preferred for healing DFUs. CONCLUSIONS The nine dressings evaluated in this study had different advantages in promoting the healing of DFU, but most differences among the dressings were not significant. According to the analysis of rank probability, amniotic membrane and hydrogel dressings are the most advantageous in terms of promoting DFU healing. It is recommended that the most suitable dressing should be selected taking into consideration exudate control, comfort, and cost.
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Affiliation(s)
- Xu Zhang
- Department of Nursing, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Liaoning, China
| | - Di Sun
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Liaoning, China
| | - Gui Chun Jiang
- Department of Nursing, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Liaoning, China
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Antibacterial effect and wound healing ability of silver nanoparticles incorporation into chitosan-based nanofibrous membranes. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 98:1053-1063. [DOI: 10.1016/j.msec.2019.01.073] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/16/2018] [Accepted: 01/16/2019] [Indexed: 11/18/2022]
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Colenci R, Abbade LPF. Fundamental aspects of the local approach to cutaneous ulcers. An Bras Dermatol 2019; 93:859-870. [PMID: 30484531 PMCID: PMC6256234 DOI: 10.1590/abd1806-4841.20187812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/31/2018] [Indexed: 01/13/2023] Open
Abstract
Ulcers or wounds can be classified as acute or chronic. Their treatment involves overall assessment of the patient and choice of suitable local therapy, and the appropriate indication and use of products. Technological progress in the field of wound treatment has increased rapidly. Constant updating, with emphasis on available scientific evidence, is necessary to offer the best approaches to patients with acute and chronic wounds. A qualitative analysis of literature was conducted to identify scientific publications that update the concepts involved in local wound treatment, to present some resources that can aid the healing process and describe the different types of dressings available. This review includes wound assessment using the acronym TIME (tissue, infection/inflammation, moisture balance and edge of wound), cleaning and debridement, infection/inflammation control, exudate control, dressing types and main indications.
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Affiliation(s)
- Raquel Colenci
- Technical Section of Nursing in Dermatology, Hospital das
Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista,
Botucatu (SP), Brazil
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Abstract
GENERAL PURPOSE To provide information on the use of topical antimicrobial agents for the treatment of chronic wounds. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Examine features of wounds and wound healing as well as the purpose of specific antimicrobial agents.2. Identify potential therapeutic and adverse effects of specific topical antimicrobial agents for the treatment of chronic wounds. ABSTRACT Bacteria can delay or prevent healing in the surface compartment of a chronic wound or invade the deep and surrounding structures. This article focuses on the superficial compartment and the appropriate use of topical antimicrobial therapies. The authors have reviewed the published evidence for the last 5 years (2012-2017) and extrapolated findings to clinical practice with critical appraisal and synthesis of the recent literature with expert opinion, patient-centered concerns, and healthcare systems perspectives. Summary evidence tables for commonly used topical antimicrobials are included.
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31
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Perspectives on antibacterial performance of silver nanoparticle-loaded three-dimensional polymeric constructs. Biointerphases 2018; 13:06E404. [PMID: 30261733 DOI: 10.1116/1.5042426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Silver nanoparticle (AgNP)-loaded polymeric constructs are widely investigated for potential applications as drug delivery systems, wound dressings, and antibiofouling biomaterials. Herein, the authors present several methods for fabricating such materials and evaluate their efficacy against Escherichia coli. H2O(v) plasma surface modification is employed to enhance material surface wettability (explored by water contact angle goniometry) and nanoparticle incorporation. Compositional analyses reveal that incorporation of AgNPs on the surface and bulk of the materials strongly depends on the fabrication methodology. More importantly, the nature of AgNP incorporation into the polymer has direct implications on the biocidal performance resulting from the release of Ag+. The materials fabricated herein fell significantly short of healthcare standards with respect to antimicrobial behavior, and, in comparing their results to numerous literature studies, the authors identified a glaring disparity in the way such results are often described. Thus, this work also contains a critical evaluation of the literature, highlighting select poor-performing materials to demonstrate several shortcomings in the quantitative analysis and reporting of the antibacterial efficacy of AgNP-loaded materials. Ultimately, recommendations for best practices for better evaluation of these constructs toward improved antibacterial efficacy in medical settings are provided.
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32
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New Silver Complexes with Mixed Thiazolidine and Phosphine Ligands as Highly Potent Antimalarial and Anticancer Agents. J CHEM-NY 2018. [DOI: 10.1155/2018/8395374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Five silver(I) complexes containing a mixed ligand system of phosphine and thiazolidine were successfully synthesized. The structural information of the complexes was assembled using various spectroscopic techniques such as CHN elemental analysis, Fourier transformed infrared (FTIR), 1H, 13C, and 31P{1H} NMR spectroscopy, and thermogravimetric analysis (TGA). A bidentate phosphine ligand acted as a chelating agent which bond to the silver in 1 : 2 molar ratios. Meanwhile, thiazolidine was attached to the silver in a 1 : 1 molar ratio. The antiplasmodial properties of all synthesized complexes were investigated on chloroquine-resistant P. falciparum parasite via HRP2 assays and cytotoxicity tests on Vero cells. Of all the synthesized complexes, complex 2 showed the highest SI value (more than 12.4) followed by complex 5 (6.6). The potent properties of compounds 2 and 5 were also noted in the in vitro antiproliferative assays involving MDA-MB-231 and MCF-7 breast cancer cell lines as well as HT-29 colon cancer cell line. Complex 2 was selective for MDA-MB-231 cells (GI50 = 1.9 ± 0.3 µM), while complex 5 acted predominantly on breast carcinoma cells (GI50 MDA-MB-231 = 4.7 ± 1.1 µM; MCF-7 = 2.9 ± 0.9 µM) instead of colon carcinoma (HT-29) cells (GI50 = 15.1 ± 1.9 µM).
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Gold K, Slay B, Knackstedt M, Gaharwar AK. Antimicrobial Activity of Metal and Metal‐Oxide Based Nanoparticles. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201700033] [Citation(s) in RCA: 233] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Karli Gold
- Department of Biomedical Engineering Texas A&M University College Station TX 77843 USA
| | - Buford Slay
- Department of Biomedical Engineering Texas A&M University College Station TX 77843 USA
| | - Mark Knackstedt
- Department of Biomedical Engineering Texas A&M University College Station TX 77843 USA
| | - Akhilesh K. Gaharwar
- Department of Biomedical Engineering Texas A&M University College Station TX 77843 USA
- Department of Materials Science and Engineering Texas A&M University College Station TX 77843 USA
- Center for Remote Health and Technology Texas A&M University College Station TX 77843 USA
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Brouillard C, Bursztejn AC, Latarche C, Cuny JF, Truchetet F, Goullé JP, Schmutz JL. Silver absorption and toxicity evaluation of silver wound dressings in 40 patients with chronic wounds. J Eur Acad Dermatol Venereol 2018; 32:2295-2299. [PMID: 29730878 DOI: 10.1111/jdv.15055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/16/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Silver-containing dressings are considered to be safe even though there have been some reports of complications, including argyria and various organ system dysfunctions. Despite the widespread use of silver dressings, little research has been done regarding the absorption and toxicity of silver. OBJECTIVE We aimed to study the systemic absorption of silver in patients with chronic inflammatory wounds and to determine associated factors of systemic silver absorption and evaluated its association with silver toxicity. PATIENTS AND METHOD Prospective, longitudinal, observational, multicentre, open-label pilot study. Patients from the Dermatology Departments of Lorraine (France) with the following inclusion criteria: (i) a chronic wound of more than 6 weeks and (ii) an ulcer needing silver-containing dressing were included. Before and after 28 days of treatment, clinical characteristics of the wound were recorded; hemogram, hepatic and renal functions, albumin sera and serum silver level were measured. RESULTS Half of the cases displayed raised levels of silver after 1 month of treatment. Predictive factors for systemic silver absorption were wound area, anaemia and malnutrition with anaemia and malnutrition confirmed on multivariate analysis. Wound vascularization may also play a role, as a higher absorption was observed in cases of wound granulation without arterial components. No toxicity was detected. This work has also emphasized the slow elimination of silver from the body. CONCLUSION Both long-term application and iterative treatments with silver dressings should be discouraged, especially in the elderly, who often suffer from malnutrition and anaemia to avoid potential cumulative toxicity.
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Affiliation(s)
- C Brouillard
- Department of Dermatology, Nancy University Hospital, Nancy, France
| | - A-C Bursztejn
- Department of Dermatology, Nancy University Hospital, Nancy, France
| | - C Latarche
- Department of Epidemiology, Nancy University Hospital, Nancy, France
| | - J-F Cuny
- Department of Dermatology, Nancy University Hospital, Nancy, France
| | - F Truchetet
- Department of Dermatology, Metz-Thionville Regional Hospital, Thionville, France
| | - J-P Goullé
- Department of Toxicology, Le Havre Hospital, Le Havre, France
| | - J-L Schmutz
- Department of Dermatology, Nancy University Hospital, Nancy, France
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Bastos CAP, Faria N, Ivask A, Bondarenko OM, Kahru A, Powell J. Ligand-Doped Copper Oxo-hydroxide Nanoparticles are Effective Antimicrobials. NANOSCALE RESEARCH LETTERS 2018; 13:111. [PMID: 29675656 PMCID: PMC5908776 DOI: 10.1186/s11671-018-2520-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
Bacterial resistance to antimicrobial therapies is an increasing clinical problem. This is as true for topical applications as it is for systemic therapy. Topically, copper ions may be effective and cheap antimicrobials that act through multiple pathways thereby limiting opportunities to bacteria for resistance. However, the chemistry of copper does not lend itself to facile formulations that will readily release copper ions at biologically compatible pHs. Here, we have developed nanoparticulate copper hydroxide adipate tartrate (CHAT) as a cheap, safe, and readily synthesised material that should enable antimicrobial copper ion release in an infected wound environment.First, we synthesised CHAT and showed that this had disperse aquated particle sizes of 2-5 nm and a mean zeta potential of - 40 mV. Next, when diluted into bacterial medium, CHAT demonstrated similar efficacy to copper chloride against Escherichia coli and Staphylococcus aureus, with dose-dependent activity occurring mostly around 12.5-50 mg/L of copper. Indeed, at these levels, CHAT very rapidly dissolved and, as confirmed by a bacterial copper biosensor, showed identical intracellular loading to copper ions derived from copper chloride. However, when formulated at 250 mg/L in a topically applied matrix, namely hydroxyethyl cellulose, the benefit of CHAT over copper chloride was apparent. The former yielded rapid sustained release of copper within the bactericidal range, but the copper chloride, which formed insoluble precipitates at such concentration and pH, achieved a maximum release of 10 ± 7 mg/L copper by 24 h.We provide a practical formulation for topical copper-based antimicrobial therapy. Further studies, especially in vivo, are merited.
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Affiliation(s)
- Carlos A P Bastos
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
- Biomineral Research Group, Department of Mineral Science and Technology, MRC Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.
| | - Nuno Faria
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
- Biomineral Research Group, Department of Mineral Science and Technology, MRC Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.
| | - Angela Ivask
- National Institute of Chemical Physics and Biophysics, Laboratory of Environmental Toxicology, Akadeemia tee 23, 12618, Tallinn, Estonia.
| | - Olesja M Bondarenko
- National Institute of Chemical Physics and Biophysics, Laboratory of Environmental Toxicology, Akadeemia tee 23, 12618, Tallinn, Estonia
| | - Anne Kahru
- National Institute of Chemical Physics and Biophysics, Laboratory of Environmental Toxicology, Akadeemia tee 23, 12618, Tallinn, Estonia
- Estonian Academy of Sciences, Kohtu 6, 10130, Tallinn, Estonia
| | - Jonathan Powell
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
- Biomineral Research Group, Department of Mineral Science and Technology, MRC Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK
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Dissemond J, Böttrich JG, Braunwarth H, Hilt J, Wilken P, Münter KC. Evidence for silver in wound care - meta-analysis of clinical studies from 2000-2015. J Dtsch Dermatol Ges 2018; 15:524-535. [PMID: 28485879 DOI: 10.1111/ddg.13233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Given that the scientific evidence for silver in wound care is generally considered insufficient, there is uncertainty among users regarding its clinical use. MATERIAL AND METHODS A group of experts evaluated the clinical studies on silver in wound management published from 2000-2015. RESULTS Overall, 851 articles were identified, 173 of which were included and categorized. There were 31 randomized controlled trials (RCTs) and eight cohort studies. Twenty-eight of these studies showed statistically significant outcome parameters in support of silver. While nine of these studies investigated burn injuries, 20 addressed other indications (venous leg ulcers: 9; pressure ulcers: 3; chronic wounds: 2; diabetic foot ulcer: 1; other types of wounds: 5). In 16 studies, the primary parameter was wound healing, whereas quality of life including pain was assessed in twelve studies; cost-effectiveness, in eight studies; reduction of bacterial load, in three studies. Based on these results, a treatment algorithm for the clinical use of silver in wound care has been developed. CONCLUSIONS The present meta-analysis shows that the evidence base for silver in wound management is significantly better than perceived in the current scientific debate. Thus, if used selectively and for a limited period of time, silver not only has antimicrobial effects but is also characterized by an improvement in quality of life and good cost-effectiveness.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
| | | | | | - Jörg Hilt
- Smith & Nephew GmbH, Hamburg, Germany
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Jindal R, Dekiwadia DB, Krishna PR, Khanna AK, Patel MD, Padaria S, Varghese R. Evidence-Based Clinical Practice Points for the Management of Venous Ulcers. Indian J Surg 2018; 80:171-182. [PMID: 29915484 DOI: 10.1007/s12262-018-1726-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022] Open
Abstract
Venous ulcer is an extremely common aetiology of lower extremity ulceration, which affects approximately 1% population in most of the countries, and the incidence rate increases with age and female gender. Proper assessment and diagnosis of both the patient and ulcer are inevitable in order to differentiate venous ulcers from other lower extremity ulceration and to frame an adequate and individualised management plan. Venous ulcers generally persist for weeks to many years and are typically recurrent in nature. This consensus aims to present an evidence-based management approach for the patients with venous ulcers. Various management options for venous ulcers include compression therapy, minimally invasive procedures like sclerotherapy and ablation techniques, surgical procedures, debridement and medical management with micronised purified flavonoid fraction (MPFF). Compression therapy is the mainstay treatment for venous ulcer. However, in failure cases, surgery can be preferred. Medical management with MPFF as an adjuvant therapy to standard treatment has been reported to be effective and safe in patients with venous ulcer. In addition to standard therapy, diet and lifestyle modification including progressive resistance exercise, patient education, leg elevation, weight reduction, maintaining a healthy cardiac status and strong psychosocial support reduces the risk of recurrence and improves the quality of life in patients with venous ulcer.
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Affiliation(s)
| | | | | | - Ajay K Khanna
- 4Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Shoaib Padaria
- Jaslok Hospital, Breach Candy Hospital, Sir H.N. Hospital, Saifee Hospital, Mumbai, India
| | - Roy Varghese
- 7Daya Hospital, Jubilee Mission Medical College, Trichur, Kerala India
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Hall C, Hardin C, Corkins CJ, Jiwani AZ, Fletcher J, Carlsson A, Chan R. Pathophysiologic Mechanisms and Current Treatments for Cutaneous Sequelae of Burn Wounds. Compr Physiol 2017; 8:371-405. [PMID: 29357133 DOI: 10.1002/cphy.c170016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Burn injuries are a pervasive clinical problem. Extensive thermal trauma can be life-threatening or result in long-lasting complications, generating a significant impact on quality of life for patients as well as a cost burden to the healthcare system. The importance of addressing global or systemic issues such as resuscitation and management of inhalation injuries is not disputed but is beyond the scope of this review, which focuses on cutaneous pathophysiologic mechanisms for current treatments, both in the acute and long-term settings. Pathophysiological mechanisms of burn progression and wound healing are mediated by highly complex cascades of cellular and biochemical events, which become dysregulated in slow-healing wounds such as burns. Burns can result in fibroproliferative scarring, skin contractures, or chronic wounds that take weeks or months to heal. Burn injuries are highly individualized owing to wound-specific differences such as burn depth and surface area, in addition to patient-specific factors including genetics, immune competency, and age. Other extrinsic complications such as microbial infection can complicate wound healing, resulting in prolonged inflammation and delayed re-epithelialization. Although mortality is decreasing with advancements in burn care, morbidity from postburn deformities continues to be a challenge. Optimizing specialized acute care and late burn outcome intervention on a patient-by-patient basis is critical for successful management of burn wounds and the associated pathological scar outcome. Understanding the fundamentals of integument physiology and the cellular processes involved in wound healing is essential for designing effective treatment strategies for burn wound care as well as development of future therapies. Published 2018. Compr Physiol 8:371-405, 2018.
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Affiliation(s)
- Caroline Hall
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - Carolyn Hardin
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - Christopher J Corkins
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA.,Clinical Division and Burn Center, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - Alisha Z Jiwani
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA.,Clinical Division and Burn Center, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - John Fletcher
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA.,Clinical Division and Burn Center, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - Anders Carlsson
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA.,Clinical Division and Burn Center, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - Rodney Chan
- Quality Skin Collaborative for Advanced Reconstruction and Regeneration (Q-SCARRTM), Dental Craniofacial Trauma Research Division, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA.,Clinical Division and Burn Center, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
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40
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Davies P, McCarty S, Hamberg K. Silver-containing foam dressings with Safetac: a review of the scientific and clinical data. J Wound Care 2017; 26:S1-S32. [DOI: 10.12968/jowc.2017.26.sup6a.s1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Dissemond J, Böttrich JG, Braunwarth H, Hilt J, Wilken P, Münter KC. Evidenz von Silber in der Wundbehandlung - Metaanalyse der klinischen Studien von 2000-2015. J Dtsch Dermatol Ges 2017; 15:524-536. [DOI: 10.1111/ddg.13233_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/27/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Essen
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42
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Njogu EM, Omondi B, Nyamori VO. Silver(I)-pyridinyl Schiff base complexes: Synthesis, characterisation and antimicrobial studies. J Mol Struct 2017. [DOI: 10.1016/j.molstruc.2017.01.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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43
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Abstract
Each year around £3.3 billion is spent on wound care in the community. Community nurses care for around 730 000 with leg ulcers each year and around 284 000 people still have a leg ulcer after a year. This article explores the issue of hard to heal leg ulcers and what community nurses can do to improve healing rates and improve quality of life for people with leg ulcers.
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Affiliation(s)
- Linda Nazarko
- Nurse Consultant Physical Health Care at West London Mental Health NHS Trust
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44
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Dalac S, Sigal L, Addala A, Chahim M, Faivre-Carrere C, Lemdjadi Z, Bohbot S. Clinical evaluation of a dressing with poly absorbent fibres and a silver matrix for managing chronic wounds at risk of infection: a non comparative trial. J Wound Care 2017; 25:531-8. [PMID: 27608514 DOI: 10.12968/jowc.2016.25.9.531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the efficacy, safety and acceptability of a new silver poly absorbent dressing (UrgoCleanAg) in the local management of exudative chronic wounds at risk of infection, with inflammatory signs suggesting heavy bacterial load. METHOD This prospective, multicentre, non-comparative clinical trial was conducted in French hospital wards (dermatology and vascular medicine) or specialised private-practice physicians. Patients were considered at high-risk of infection when presenting with at least three of five selected inflammatory clinical signs, suggesting a heavy bacterial load (pain between two dressing changes, erythema, oedema, malodorous wound and presence of a heavy exudate). They were treated for a maximum period of four weeks, and followed by the physician on a weekly basis, including a clinical examination, area tracings and photographs. The primary efficacy criterion of the trial was the relative wound surface area reduction at the end of the four weeks of treatment. Acceptability was documented by the nursing staff at each dressing change between the weekly evaluations. RESULTS We recruited 37 patients with chronic wounds. Wound surface area, mostly covered by sloughy tissue, was reduced by 32.5% at the end of the treatment (median value), while the clinical score (maximum value of 5, based on inflammatory clinical signs) decreased from 4.0 to 2.0. Effective debridement properties were documented (62.5% relative reduction of sloughy tissue at week 4; 58.8% of debrided wounds at week 4) and improvement of the periwound skin status was noted (healthy for 28.6% of the patients at week 4 versus 2.7% at baseline). In addition, the tested wound dressing presented a good safety profile associated to a high level of acceptability, noted by both patients and nursing staff. CONCLUSION These clinical data support that the tested dressing is a credible therapeutic alternative for the management of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load.
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Affiliation(s)
- S Dalac
- Dermatology Department. Bocage University Hospital. Dijon. France
| | - L Sigal
- Head of Dermatology Department, Victor Dupouy Hospital. Argenteuil. France
| | - A Addala
- Department of Vascular Medicine. Edouard Herriot Hospital. Lyon. France
| | - M Chahim
- Vascular Physician, Angiologist, Corentin Celton Hospital. Paris. France
| | - C Faivre-Carrere
- Angiologist, Wound Healing Center. General Hospital. Saint Gaudens. France
| | - Z Lemdjadi
- Clinical Research Department. Laboratoires Urgo. Chenôve. France
| | - S Bohbot
- Medical Director, Laboratoires Urgo. Chenôve. France
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45
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Powers JG, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds: Chronic wound care and management. J Am Acad Dermatol 2016; 74:607-25; quiz 625-6. [PMID: 26979353 DOI: 10.1016/j.jaad.2015.08.070] [Citation(s) in RCA: 343] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 12/15/2022]
Abstract
In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers.
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Affiliation(s)
| | - Catherine Higham
- Vanderbilt School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Karen Broussard
- Division of Dermatology, Vanderbilt University, Nashville, Tennessee
| | - Tania J Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts; SkinCare Physicians, Chestnut Hill, Massachusetts
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46
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Cullum N, Buckley H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Goncalves PS, Soares M, Stubbs N. Wounds research for patient benefit: a 5-year programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04130] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Nicky Cullum
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Hannah Buckley
- Department of Health Sciences, University of York, York, UK
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | - Richard Morley
- Department of Health Sciences, University of York, York, UK
| | - Susan O’Meara
- Department of Health Sciences, University of York, York, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
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47
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Radiation synthesis and characterization of polyvinyl alcohol/chitosan/silver nanocomposite membranes: antimicrobial and blood compatibility studies. Polym Bull (Berl) 2016. [DOI: 10.1007/s00289-016-1708-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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48
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Paladini F, Di Franco C, Panico A, Scamarcio G, Sannino A, Pollini M. In Vitro Assessment of the Antibacterial Potential of Silver Nano-Coatings on Cotton Gauzes for Prevention of Wound Infections. MATERIALS 2016; 9:ma9060411. [PMID: 28773531 PMCID: PMC5456794 DOI: 10.3390/ma9060411] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 12/20/2022]
Abstract
Multidrug-resistant organisms are increasingly implicated in acute and chronic wound infections, thus compromising the chance of therapeutic options. The resistance to conventional antibiotics demonstrated by some bacterial strains has encouraged new approaches for the prevention of infections in wounds and burns, among them the use of silver compounds and nanocrystalline silver. Recently, silver wound dressings have become widely accepted in wound healing centers and are commercially available. In this work, novel antibacterial wound dressings have been developed through a silver deposition technology based on the photochemical synthesis of silver nanoparticles. The devices obtained are completely natural and the silver coatings are characterized by an excellent adhesion without the use of any binder. The silver-treated cotton gauzes were characterized through scanning electron microscopy (SEM) and thermo-gravimetric analysis (TGA) in order to verify the distribution and the dimension of the silver particles on the cotton fibers. The effectiveness of the silver-treated gauzes in reducing the bacterial growth and biofilm proliferation has been demonstrated through agar diffusion tests, bacterial enumeration test, biofilm quantification tests, fluorescence and SEM microscopy. Moreover, potential cytotoxicity of the silver coating was evaluated through 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide colorimetric assay (MTT) and the extract method on fibroblasts and keratinocytes. Inductively coupled plasma mass spectrometry (ICP-MS) was performed in order to determine the silver release in different media and to relate the results to the biological characterization. All the results obtained were compared with plain gauzes as a negative control, as well as gauzes treated with a higher silver percentage as a positive control.
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Affiliation(s)
- Federica Paladini
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
| | | | - Angelica Panico
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
| | - Gaetano Scamarcio
- CNR-IFN U.O.S. Bari, Via Amendola 173, Bari 70126, Italy.
- Dipartimento Interateneo di Fisica, University of Bari Aldo Moro, Via Amendola 173, Bari 70126, Italy.
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
| | - Mauro Pollini
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
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49
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Dhatariya K, Gooday C, Franke B, Pilling T, Flanagan A, Zeidan L. An open, non-comparative, multicentre evaluation of performance and safety using an antimicrobial exudate transfer dressing on diabetic foot ulcers: a case series. J Wound Care 2016; 25:256-65. [DOI: 10.12968/jowc.2016.25.5.256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- K. Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich United Kingdom
| | - C. Gooday
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich United Kingdom
| | - B. Franke
- The Rotherham NHS Foundation Trust, Rotherham
| | - T. Pilling
- The Rotherham NHS Foundation Trust, Rotherham
| | - A. Flanagan
- The Rotherham NHS Foundation Trust, Rotherham
| | - L. Zeidan
- The Rotherham NHS Foundation Trust, Rotherham
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50
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Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, Woo K, Romanelli M, Kirsner RS. What's new: Management of venous leg ulcers. J Am Acad Dermatol 2016; 74:643-64; quiz 665-6. [DOI: 10.1016/j.jaad.2015.03.059] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/28/2015] [Accepted: 03/30/2015] [Indexed: 12/31/2022]
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