Partial closure of skin wounds after kidney transplantation decreases the incidence of postoperative wound infections

Frequency of Complications After Kidney Transplant in the Early Postoperative Period

OBJECTIVES

Complications after kidney transplant can be divided into surgical and nonsurgical. Our study investigated the incidence of postoperative complications and types of complications in a single center.

MATERIALS AND METHODS

We retrospectively analyzed the occurrence of postoperative complications in 220 patients who underwent kidney transplantation at the Republican Scientific Center for Emergency Medical Care (Tashkent, Republic of Uzbekistan) from January 2019 to October 2022.

RESULTS

Among the 220 patients, various types of complications were observed in 42 cases (19.1%). Of these, 31 patients (73.8%) had surgical complications and 11 patients (26.2%) had nonsurgical complications. Surgical complications included hematoma of the postoperative wound in 8 patients (19.2%), thrombosis of the graft artery in 1 patient (2.4%), thrombosis of the venous anastomosis in 1 patient (2.4%), lymphocele of the postoperative wound in 7 patients (16.6%), wound infections 4 patients (9.5%), bleeding from the arterial anastomosis 2 patients (4.7%), bleeding from the venous anastomosis 1 patient (2.4%), kink of the venous anastomosis in 3 patients (7.2%), postoperative hernia in 2 patients (4.7%), and urological complications in the form of ureteral necrosis in 2 patients (4.7%). Nonsurgical complications included hyperacute rejection, which led to the removal of the graft, in 2 patients (4.8%), acute cellular rejection of the graft, which was successfully treated with methylprednisolone pulse therapy, in 4 patients (9.5%), delayed graft function in 1 patients (2.4%) case, and posttransplant diabetes mellitus in 4 patients (9.5%).

CONCLUSIONS

Despite the frequency of postoperative complications, timely assistance and further monitoring of patients can lead to normal functioning of the kidney transplant, except for cases of hyperacute rejection.

Design and Development of Naringin Loaded Proposomal Gel for Wound Healing

BACKGROUND

The injuries or wounds caused by various means will impact human lives severely. An increase in the demand for wounds or burns was observed. For better wound healing and to combat the free radical effect on the healing process, wounds must be treated with multifunctional or multipurpose dressing or gel or any other type of biomaterial.

OBJECTIVES

The study aims to develop, optimize, and evaluate the naringin-loaded proposomal gel (PPG) for quick wound healing.

METHODS

The central composite design was employed for the optimization of proposomes. Naringin-loaded proposomes were evaluated for percentage entrapment efficiency (EE), the particle size of proposomes (PsP), and the zeta potential of proposomes (ZpP). The change in drug release profile was studied by dissolution. Furthermore, naringin and naringin-loaded proposomes, antioxidant activity was determined by 2,2- diphenyl-1-picrylhydrazyl hydrate (DPPH) reagent and ascorbic acid as a reference standard. Different gel bases were prepared, and based on various parameters, the G2 (0.6 % Carbopol 974) gel base was selected for naringin proposomes loading. The naringin-loaded PPG was evaluated for various in vitro and in vivo wound healing properties.

RESULTS

The optimized naringin-loaded proposomes showed extended drug release (90.78 ± 2.19%) for 72 h. The naringin-loaded PPG improved the permeability of naringin, which showed 28.91 ± 2.81% of drug release after 96 h, and the drug solution showed 9.05 ± 0.92%. IC50 values of antioxidant activity of naringin and naringin proposomes were found to be 337.31 μg/ mL and 201.86 μg/ mL, respectively. The naringin-loaded PPG showed better-wound closure on the 15^th day (3.32%) compared to proposomal solution (4.75%) or naringin topical gel (4.2%).

CONCLUSION

Based on the obtained results, we conclude naringin-loaded PPG can be an alternative strategic approach to deliver the naringin for quick wound healing.

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

BACKGROUND

Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients.

METHODS

A systematic review of the literature was conducted.

RESULTS

Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed.

CONCLUSION

Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.