Animal and Human Bite Wounds

[Trauma surgical relevance of bite injuries by animals and humans]

Bite injuries require differentiated treatment due to the deeply inoculated polymicrobial pathogen spectrum, possible concomitant injuries and pronounced soft tissue damage. Dog bites are the most common bite injuries but are less complicated to heal than human and cat bites. The location of the bite greatly depends on the age and the size of the bite victim as well as the type of bite perpetrator. In every case detection of the pathogen should be carried out to provide the best possible adapted treatment in the event of an exacerbation. The primary antibiotic treatment should be empirical with amoxicillin + clavulanic acid or ampicillin + sulbactam and, if necessary, adjusted according to the antibiogram. Depending on the findings, surgical treatment includes excision of the bite canal and a customized wound debridement. It is important to check the vaccination status of those involved and if indicated, to carry out postexposure prophylaxis for tetanus and rabies.

A Pediatric Level III Trauma Center Experience With Dog Bite Injuries

Dog bite injuries often present to Emergency Departments (ED), and between 2001 and 2003, approximately 4.5 million adults and children were injured. Injuries may range from puncture wounds to deep tissue lacerations or avulsions. Deaths have been described. Our objective was to describe dog bite injuries, the overall location of injuries, and need for vaccination among children who presented to a Pediatric ED designated as a level III trauma center with a robust facial surgical infrastructure. This was a 6-year retrospective study. Charts were identified by International Classification of Diseases, Tenth Revision (ICD-10) codes for lacerations or injuries secondary to animal bites and accessing the hospital's trauma database. Variables abstracted were age, sex, type of injury, location, need for antibiotics, immunization states and requirement of tetanus or rabies vaccine, disposition from ED to the operating room, home, or any in-patient unit. We excluded children older than 17 years of age and children who had a post-bite injury infection or injury not initially managed in our facility or medical system. The final cohort consisted of 152 children. The median age was 52 months and age ranged from 2 to 215 months. Children with a single bite injury were older when compared with those with numerous injuries, 81 and 62 months of age, respectively. Among young children, 75% of injuries occurred above the neck and 15.1% were managed in the operating room. Twenty-four percent of children required either a tetanus or rabies vaccination. Most dog bite injuries occurred to facial structures. Comprehensive care of dog victims included awareness of both dog and injured child vaccination status.

Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections-A Five-Year Retrospective Study

Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.

All the Better to Taste You With, My Dear: ED Management of Mammalian Bites

Mammal bites account for over 5 million visits to Emergency Departments (EDs) annually. Nurse Practitioners (NPs) need to stay abreast of current guidelines, changes to antibiotic regimens that are now most effective, and understand in what circumstances collaboration with other specialists is indicated. It is not enough to care for the wound, itself, but rather understand in what presentations additional care may be needed despite the fact that there is no clear evidence at the time of evaluation of the need for advanced care. Additionally, NPs should understand what resources are available within their community for wound care that may exceed the scope and ability of the facility in which they practice. Health departments may need to be utilized in the care of ED patients who present with wounds that are suspicious for rabies. Finally understanding what constitutes a high, medium, and low risk bite will aide NPs in delivering optimal care within the communities they serve while also minimizing patient morbidity.

Establishment of an Animal Model of Dog Bite Injuries

Nowadays dog bite is becoming a world public health problem. Therefore, the study aimed to develop a dog bite animal model that is helpful to solve these problems. In this study, the skull of an adult dog was scanned. The three-dimensional model of the dog maxillofacial bones and dentition was built by MIMICS. Next, the model was printed with Co-Cr alloy by using selective laser sintering technology to develop the dog bite simulation pliers. Then, to simulate dog bite to most, the maximum bite force of the pliers was measured and actions contained in dog bite process was analyzed. Afterwards, according to action analysis results, rabbits were bitten by the prepared instrument in actions that simulate dog's bite. Finally, the reproducibility and controllability of this animal model of dog bite injuries was validated in an in vivo study. The results showed a reliable animal model of dog bite injuries has been developed in this study. The sites and severities of the injuries could be adjusted as the operator wishes and the animal model of dog bite injuries was highly repeatable. This study also indicates the feasibility of using digital technology in establishing animal bite models.

Suicidal wrist bites

Wrist injuries are not uncommon in forensic routine and are usually found in the context of suicides or as a result of psychiatric illnesses, e.g., borderline disorders. Sharp objects (knives, broken glass, etc.) are usually used. In the case reported here, a paranoid-schizophrenic man not only injured himself with razor blades on both wrists, but he also inflicted extensive wrist bite injuries using his dental prosthesis. In addition to the severance of flexor tendons, venous vessels and the left radial artery were torn with subsequent blood loss. At the time of death, there was also acute exposure to methadone and opiates. Patients suffering from psychotic illnesses have an increased risk of committing spectacular or bizarre suicides.

Reverse Posterior Interosseous Artery Flap for Human Bite Injury to the Hand

Bite injuries frequently occur on human hands. Human bite injuries to the hand may lead to an infection because of limited soft tissue protection and wound contamination. However, no studies have reported severe bite injuries on hands treated by flaps. We report a case of an 80-year-old woman diagnosed with a major neurocognitive disorder. The patient accidentally had a self-bite injury accompanied with an open metacarpal fracture. Debridement and fixation of the first metacarpal fracture were performed. Afterward, skin necrosis occurred gradually on the dorsum of the hand. Therefore, a reverse posterior interosseous artery (PIA) flap was used, and the postoperative course was uneventful. Given the high risk of infection, human bite injuries, particularly hand bites, should be treated immediately. Delayed treatment for such injuries may lead to extensive soft tissue defects requiring reconstruction with flaps.

Management of Human Bites in a Rural Kenyan Setting: A Plastic Surgeon's 8-Year Experience

INTRODUCTION

The treatment of human bites is a common issue facing healthcare practitioners in the developing countries of Sub-Saharan Africa where it has been noted as a growing public health concern. Generally, the desired outcomes from surgical management are healing, function, and aesthetics. We share our 8-year experience at Kapsowar Hospital in Kenya with the presentation, management, and outcome of human bites. We are uniquely situated to do so given the prevalence of human biting in our community and the full-time presence of a plastic surgeon at our institution. To the best of our knowledge, this study is the first to present human bite surgical management by a plastic surgeon certified by the American Board of Surgery working full-time on the African continent.

METHODS

A retrospective chart review was conducted on all patients who presented to the operating theater at Kapsowar Hospital with a human bite between 2013-2021. After identification of eligible patients, charts were reviewed assessing parameters including age, gender, timing from injury to presentation at hospital, localization of bite, severity of facial wounds using Lackmann's classification, surgical procedure(s), postoperative complications, surgical revisions, antibiotics administered, and circumstance of incident. Data were analyzed using SPSS 29.0.0.0.

RESULTS

Forty-four patients were identified. Seventeen (38.6%) were female and 27 (61.4%) were male. Thirty-one patients had facial bites and 13 patients had bites to other parts of the body. Of facial bites, 70.3% resulted in amputation of the affected part while 29.7% were lacerations. Using Lackmann's classification for facial bite severity, IIIA bites (complete avulsion) were most common for both males (9) and females (7). Females comprised 68.4% of total lip bite victims. Bites to the extremity were associated with late presentation and infection. We report a salvage rate of 85.7% for infected digits.

CONCLUSIONS

Compared with most other studies on human bites, our patient population presents with a higher rate of avulsive lip injuries, most commonly among women. Our postoperative infection rate is lower than many others reported in the literature. Satisfactory cosmetic outcome with low risk of infection can be achieved by following well-established principles of wound healing and tension-free closure.

Animal Bite Injuries to the Face: A Retrospective Evaluation of 111 Cases

The treatment of bite wounds to the face is discussed controversially in relation to surgery and antibiotics. The aim of this study is a retrospective evaluation of 111 cases of animal bite injuries to the face that presented to our unit of oral and maxillofacial surgery over a 13-year period. Children under 10 years of age were predominantly involved. A total of 94.5% of the assessed injuries were caused by dogs. Wound infections occurred in 8.1%. Lackmann type II was the most common type of injury (36.9%). The perioral area was affected most frequently (40.5%). Primary wound closure was carried out in 74.8% of the cases. In 91.9% of the cases, antibiotic prophylaxis was prescribed. The most often administered type of antibiotic was amoxicillin with clavulanic acid (62.1%). Patients without antibiotics showed an increased infection rate without significance. Wound infections occurred significantly more frequently in wounds to the cheeks (p = 0.003) and when local flap reconstruction was necessary (p = 0.048). Compared to the other surgical treatment options, primary closure showed the lowest infection rates (4.8%, p = 0.029). We recommend antibiotic prophylaxis using amoxicillin with clavulanic acid and wound drains for wounds of Lackmann class II or higher. Primary closure seems to be the treatment of choice whenever possible.

Bite wound and mauling of a zookeeper by a gorilla

The majority of bite wounds that we encounter in the emergency department are caused by dogs, cats and humans, but bite injuries can be caused by a variety of animals. Here, we describe a case of bite wound and trauma caused by a large gorilla (Western lowland gorilla) weighing over 170 kg. Gorilla bites are rare, and the patient had an open fracture of the right distal radioulna in addition to multiple bite wounds. Treatment required careful consideration of gorilla antigenicity and a literature review to guide the selection of appropriate antimicrobial agents. Furthermore, trauma inflicted by large animals tends to require systemic traumatological screening, and patients can develop acute stress disorder because of a fear of being attacked again; therefore, early psychiatric intervention is important.

Presentation and treatment of animal and human bite injuries at a Swiss tertiary emergency department: a cross-sectional study

BACKGROUND

Animal and human bite injuries are a relevant health problem worldwide. With the increasing number of pets, bite injuries are becoming more frequent. Previous studies on animal and human bite injuries in Switzerland were completed several years ago. The aim of the present study was to provide a detailed overview of patients with bite injuries admitted to a tertiary emergency department in Switzerland in terms of demographics, injury patterns and treatment strategies.

METHODS

A 9-year cross-sectional analysis of patients presenting to the emergency department of Bern University Hospital in the period January 2013 to December 2021 following an animal or human bite injury.

RESULTS

A total of 829 patients with bite injuries were identified, including 70 for postexposure prophylaxis only. Their median age was 39 (IQR 27-54) years and 53.6% were female. Most patients were bitten by a dog (44.3%), followed by cats (31.5%) and humans (15.2%). Most bite injuries were mild (80.2%); severe injuries were mainly found in dog bites (28.3%). Most patients were treated within six hours after human (80.9%) or dog (61.6%) bites; after cat bites, patients often presented with a delay (74.5%) and signs of infection (73.6%). Human bite wounds were superficial in the majority of cases (95.7%), rarely showed signs of infection (5.2%) at the time of presentation and hospitalisation was never required.

CONCLUSIONS

Our study provides a detailed overview of patients admitted to an emergency department of a tertiary Swiss University Hospital after an animal or human bite. In summary, bite injuries are common among patients who present to the emergency department. Therefore, primary and emergency care clinicians should be familiar with these injuries and their treatment strategies. The high risk of infection, particularly in cat bites, may warrant surgical debridement in the initial treatment of these patients. Prophylactic antibiotic therapy and close follow-up examinations are recommended in most cases.

The Determinants of Non-compliance on Rabies Vaccination in North-West Peninsular Malaysia

INTRODUCTION

Rabies post-exposure vaccination (Rabies PEV) remains the most fundamental prevention of human Rabies if administered in a timely and appropriate manner. The study was aimed to determine the proportion and determinants of non-compliance on Rabies PEV among dog bite patients in Perlis, Malaysia from July 2015 to June 2020.

METHODS

A retrospective cohort study was conducted using Perlis Rabid Potential Animal Bite Registry data. Independent variables and compliance status were obtained from the registry. Logistic regression analysis was utilized on 507 dog bite patients.

RESULTS

Most of dog bite patients were age group of 46-60 years old (23.1%), male (61.3%), Chinese (49.5%), seeking treatment less than 24 h after the exposure (78.3%), category two of exposure (76.3%) and bitten on lower extremities (57.8%) by an owned dog (58.4%). Only 19.5% were non-compliance to Rabies PEV. Siamese had significantly two-timed (AOR: 2.00; 95% CI 1.06, 3.76) odd higher to become non-compliance. Being bitten during 3rd (AOR: 0.27; 95% CI 0.12, 0.59), 4th (AOR: 0.24; 95% CI 0.11, 0.52) and 5th (AOR: 0.20; 95% CI 0.09, 0.44) year of the outbreak had significantly lower odds to non-comply with Rabies PEV.

CONCLUSION

19.5% of dog bite patients still did not comply with the Rabies PEV series. Siamese would likely to non-comply whereas bitten on the 3rd, 4th and 5th years of outbreak less tendency to non-comply. Continuous health promotion to the public in the various languages despite outbreak status are ongoing to improve the perception of risk and benefit toward compliance of Rabies PEV.

A Sublatissimus Dorsi Abscess Due to Pasteurella multocida Caused by a Cat Scratch

We encountered a 51-year-old male patient who was not immunocompromised. Thirteen days before his admission, his right forearm was scratched by his pet cat. Swelling, redness, and purulent discharge appeared at the site, but he did not seek medical attention. He developed a high fever and was hospitalized with a diagnosis of septic shock, respiratory failure, and cellulitis on plain computed tomography. After admission, the swelling on his forearm was relieved with empirical antibiotics, but the symptoms spread from his right axilla to his waist. We suspected necrotizing soft tissue infection and made a trial incision in the lateral chest up to the latissimus dorsi, but were unable to prove it. However, an abscess was later found under the muscle layer. Second incisions were made to allow the abscess to drain. The abscess was relatively serous, and no tissue necrosis was observed. The patient's symptoms improved rapidly. In retrospect, the patient probably already had the axillary abscess on admission. It may have been detected at this point if contrast-enhanced computed tomography had been performed, and early axillary drainage may have accelerated the patient's recovery, which could also have prevented the formation of the latissimus dorsi muscle abscess. In conclusion, the Pasteurella multocida infection on the patient's forearm induced a very unusual presentation and caused an abscess to form under the muscle, unlike necrotizing soft tissue infections. Early contrast-enhanced computed tomography may aid earlier and more appropriate diagnosis and treatment in such cases.

[Bite Injuries - Diagnosis and Treatment]

Bite Injuries - Diagnosis and Treatment Abstract. In Switzerland 50% of the people get bitten by an animal once in their lifetime. Almost 20% of all bite injuries lead to infections. All bite wounds should be debrided and irrigated with saline. Primary wound management is critical in terms of reducing the risk of infection. Injuries to the hands and face should be treated by a hand or plastic surgeon.

Presence of zoonotic black-pigmented periodontal pathogens in the oral microbiota of pet and stray cats

Black-pigmented bacteria are one of the neglected species to cause periodontal disease in cats, and they are also zoonotic agents that pose an infection risk to humans. In this study, we aimed to determine the presence of Porphyromonas gingivalis, Porphyromonas gulae and Prevotella nigrescens in the oral microbiota of pet and stray cats. Dental swab samples were taken from 25 pet cats and 25 stray cats with symptoms of periodontal disease and then investigated by multiplex polymerase chain reaction using 16S rRNA species-specific primers. As a result of the multiplex PCR analysis, P. gingivalis 3/25 (12%), P. nigrescens 1/25 (4%), P. gingivalis + P. gulae 7/25 (28%), P. gingivalis + P. nigrescens 1/25 (4%), P. gulae + P. nigrescens 1/25 (4%), and P. gingivalis + P. gulae + P. nigrescens 2/25 (8%) were molecularly typed in the pet cats. In addition, 1/25 (4%) of P. gulae and 21/25 (84%) of P. gingivalis + P. gulae were typed in the stray cats. In 10/25 (40%) pet and 3/25 (12%) stray cat samples, no bacteria were detected by molecular typing. In summary, the results provide strong evidence that black-pigmented zoonotic pathogens are associated with cat periodontal disease.

Oral flora of domestic cats in Hong Kong: Identification of antibiotic-resistant strains

BACKGROUND

As the clinical outcome of bite-associated infection is related to the oral commensals, evaluating their composition and antibiotic susceptibility pattern can provide more information for the antibiotic treatment of wound infections and increase the awareness of the multidrug-resistant bacteria in cat oral flora.

AIMS

This study was conducted to identify the various bacterial species in the oral cavity of cats. It aimed to identify the composition of cat oral flora and antibiotic resistant bacterial stains.

MATERIALS AND METHODS

Twenty-two cats were sampled for bacterial evaluation. Matrix-assisted laser desorption/ionization time of flight mass spectrometry was used to provide rapid and reliable detection and identification of the bacterial species. Antibiotic susceptibility tests were performed in the identified isolates to determine the antibiotic susceptibility pattern and to detect the multidrug-resistant bacteria in the cat oral cavities.

RESULTS

A total of 54 isolates were identified, Pasteurella was the genus most commonly isolated from the oral cavity of cats (19/54, 35.19%), followed by Neisseria spp. (8/54, 14.81%) and Staphylococcus spp. (7/54, 12.96%). Uncommon oral flora were isolated from the samples, including Pasteurella canis, Inquilinus limosus and the Enterobacteriaceae family of Escherichia coli, Klebsiella pneumoniae and Serratia marcescens. Fourteen different multidrug-resistant bacteria were detected, including Pasteurella species (4/14), Bacillus species (2/14), Neisseria species (3/14), Escherichia species (1/14) and Staphylococcus species (4/14).

DISCUSSION AND CONCLUSIONS

This study's findings will increase the understanding of the composition of cat oral flora in Hong Kong, which can provide more evidence-based information for the prophylactic treatment of patients with cat bite infections. Moreover, the study identified and detected the antibiotic resistance pattern and multidrug-resistant bacteria in the cat oral cavity, which can help cat owners increase their awareness of maintaining regular oral hygiene for their cats to prevent the spread of pathogens from cats to humans.

[Bite Wounds Should not be Irrigated by Syringe. An Anatomic Study]

In the literature about treatment of animal and human bite injuries, it is often recommended that bite wounds should be cleaned with a syringe and button cannula or plastic catheter. This is supposed to clean deeper wound sections and remove contamination and foreign bodies. Recent papers recommend cautious irrigation without high pressure.

MATERIAL AND METHOD

 In eight cadavers, artificial bite wounds were produced in typical locations. These wounds were irrigated by syringe and button cannula using diluted ink. The pressure of irrigation was limited to "no noticeable pressure".

RESULTS

 In all cases, more than half of the irrigation volume remained inside the victim´s organism, following anatomic structures and spreading over large areas.

CONCLUSION

Irrigation fails to clean the wound but increases the risk of contaminating the surrounding structures. Hence, the authors recommend that bite wounds should not be irrigated by syringe and button cannula.

Bite wounds to the hand - a review

Bite wounds occur as a result of bite by an animal or a human. They are relatively frequent due to the growing number of pets living with people, as well as from inadequate human-animal interactions. The knowledge of most surgeons about the management of these injuries is relatively outdated, whereas the current literature points to important changes in this field. The article presents several aspects concerning epidemiology, classification, bacteriology, and characteristics of bite wounds to the hand. Based on the actual literature, detailed rules for the management of these injuries are described. This information may prove useful in the daily practice of surgeons and doctors at emergency departments who are frequently faced with bite wounds.

Biting the hand that feeds you: Management of human and animal bites

Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.

A RETROSPECTIVE STUDY OF BITE WOUND MANAGEMENT IN RING-TAILED LEMURS (LEMUR CATTA) HOUSED WITHIN FIVE BRITISH ZOOS

Captive nonhuman primates frequently experience bite wounds inflicted by conspecifics; however, few studies evaluate wound management in these animals. This study evaluates bite wound management in 35 captive ring-tailed lemurs (RTL, Lemur catta) held within five British zoological institutions between 2015 and 2019. Treatments for 152 bite incidents resulting in 211 bite wounds were summarized. Treatment efficacy and potential risk factors for bite wound complications were evaluated for correlations with outcomes. Treatments in the first 48 hours included analgesia alone (54/152; 35.5%); analgesia and antimicrobials (42/152; 27.6%); no treatment (26/152; 17.1%); analgesia, antimicrobials, and wound management under anesthesia (24/152; 15.8%); and antimicrobials alone (6/152; 3.9%). Poor outcomes were observed in RTL in association with 20.4% of wounds (43/211): signs of pain (SOP) after 48 hours were the most common (30/211; 14.2%), followed by signs of infection (SOI, 16/211; 7.6%), wound dehiscence (7/211; 3.3%), and abnormal function or behavior at day 30 (4/ 211; 1.9%). Poor outcomes were more likely with severe bite wounds and bite wounds to the hand or limb (thoracic or pelvic, excluding the hand or foot). Specifically, SOP were more likely to be observed with severe wounds and solitary wounds, and SOI were more likely to be observed with wounds not treated with early antimicrobials. When SOI occurred, most resolved with antimicrobial treatment alone. Early analgesia is recommended for RTL with bite wounds. If SOP persist, multimodal analgesia should be administered. Clinicians should consider withholding antimicrobials for RTL with bite wounds of mild and moderate severity until SOI are observed.

Non-Fatal Attacks by Dogs: Characteristics of Victims and Attacking Dogs, From the Forensic Perspective: A Series of 106 Cases From Athens, Greece, and Brief Review of the Literature

Introduction: The close association of dogs with humans may explain the fact that dog bites are possibly the most common animal bites recorded. The relevant data concerning Greece is scarce. We aimed to study this phenomenon by describing its characteristics.

Methods: We performed a retrospective analysis of cases concerning dog attack victims, examined our Department, between 2011 and 2019. Recorded variables included sex, age, nationality, occupation, marital status, medical history, ownership status of the dog, injury anatomic location, incident time, the timing of clinical forensic examination, incapacitation time, and medical care provided.

Statistical analysis was performed using Stata/MP 13 (Stata Corp., College Station, TX) and IBM SPSS Statistics Version 20 (IBM, Armonk, NY). Statistical significance was defined as a two-sided p value of <0.05.

Results: Most incidents involved male victims (54.2%). The victim’s mean age was 44.9 years. The dog involved was unowned in 19.8% of cases. The most frequent anatomical site of injury was the legs (48.1%). Older victims suffered injuries in more sensitive areas of the body (head and neck), when compared to younger adults. Only 1.9% of victims required hospitalization. The mean incapacitation time was estimated at 5.39 days.

Conclusions: Per our results, males tend more often to be victims of dog attacks. Typically, victims are of increased age and are attacked by a dog already known to them. Most incidents take place during late winter and spring, more specifically during February and during May. The most frequently affected anatomical sites were the legs. Older people suffered injuries in more sensitive areas of the body.

Child safety programs for primary school children decrease the injury severity of dog bites

This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994-2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known: • Dog bites are a substantial healthcare problem especially in children. What is New: • This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.

Vitale anale Tierfraßverletzung durch einen Dackel

Hundebissverletzungen weisen bei Lebenden in der Regel eine charakteristische Morphologie auf, anhand derer sich die Entstehung gut nachvollziehen lässt. Haben Hunde Zugang zu einer Leiche, so kann es zu postmortalen Tierfraßverletzungen kommen, und das Verletzungsbild kann u. U. auf den ersten Blick auch als Fremdbeibringung durch Dritte missinterpretiert werden.

Vorgestellt wird ein seltener Fall einer Tierfraßverletzung an einer lebenden Person. Eine Mischintoxikation mit Zopiclon und Alkohol im häuslichen Umfeld führte zur Bewusstlosigkeit, die einen ausgedehnten Gewebsdefekt im Analbereich durch Bissverletzungen des eigenen Dackels ermöglichte. Außergewöhnlich ist hierbei neben der vitalen Entstehung auch die Lokalisation der Verletzung.

[Infections of the hand and forearm]

Infections of the hand and forearm are a frequently seen surgical emergency of the hand. Patients of all age groups are affected and underlying systemic diseases are risk factors. Posttraumatic causes are the leading cause of infections. This includes cuts and stab wounds, animal and human bites but often also minor injuries. Due to the anatomical peculiarities of the hand, rapid progression of initially inconspicuous infections can occur resulting in functional limitations. If an infection is suspected, a symptom-oriented evaluation by a hand surgeon should be performed. This includes a detailed patient history, clinical examination, laboratory analyses and imaging. This is followed by the development of an individualized and interdisciplinary treatment concept with the aim of achieving the shortest possible rehabilitation period. The treatment includes surgical cleansing of the infection, accompanied by antibiotic treatment taking the expected possible spectrum of pathogens into account. Cephalosporins and aminopenicillins in combination with beta-lactamase inhibitors are the antibiotics of first choice. Follow-up treatment includes early functional exercise under the guidance of a hand therapist to minimize postinfectious restrictions in the range of motion and to enable occupational rehabilitation. In rare cases, fulminant necrotizing infections with resulting skin and soft tissue defects can occur. In these cases, secondary plastic reconstruction is usually required after cleansing of the infection.

The wound severity of animal bite victims visiting rabies prevention clinics and the influencing factors in Central China: a cross-sectional investigation

Background

Animal bites are a major public health problem. The more serious the bite wound is, the higher the risk of developing rabies is. This study aimed to investigate the severity of wounds among animal bite victims and identify the influencing factors in Wuhan, China.

Methods

A cross-sectional study was conducted among 1015 animal bite victims visiting rabies prevention clinics. We performed a face-to-face interview to collect information on the exposure category of the bite wound, the type of the offending animal, exposure-to-risk situations, etc. Factors associated with exposure categories were identified by multivariate logistic regression analysis.

Results

Five hundred and sixty-four (55.57%) cases were category III exposures, 418 (41.18%) were category II exposures, and 33 (3.25%) were category I exposures. People who were hurt by their own domestic animals (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.14–2.10), and those exposed to animals unvaccinated against rabies (OR = 1.45, 95% CI: 1.08–1.95) had a higher risk for category III exposures. Respondents who did not know the fatality of rabies were more likely to be injured seriously compared to those who knew that rabies is fatal, and the OR was 1.40 (95% CI, 1.05–1.86).

Conclusions

This study showed that factors associated with the severity of bite wounds mainly included types of the offending animal, vaccination status of the animal, and knowledge of rabies fatality. Educational programs and awareness-raising campaigns should be provided to decrease severe animal bites, especially targeting pet owners and those with limited rabies knowledge.

Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center's Experience

The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.

[Sepsis after cat bite-How medical history, physical examination and interdisciplinary cooperation influence disease progression]

A 67-year-old woman with symptoms of shock was admitted to hospital with a suspected diagnosis of acute pulmonary artery embolism. After ruling out a thromboembolic event, sepsis was diagnosed by using the SOFA score. A CT scan of the chest with contrast revealed phlegmonous inflammation of the subcutis at the level of the right upper arm. After taking two pairs of peripheral blood samples, calculated antibiotic therapy with piperacillin/tazobactam was administered. After administration of an initial volume bolus, the patient could be transferred to the general medical ward in a stable condition with normal serum lactate level. On day one after hospital admission, blood cultures were positive for Pasteurella multocida, a gramnegative rod that belongs to the oral flora of dogs and cats. Intensified history revealed that the patient had been bitten on the forearm by her cat 2 weeks earlier. The patient did not present to a general practitioner. Despite antibiotic therapy, the patient developed increasing leukocytosis with progressive pain and swelling in the area of the right upper arm and the right ankle. On recommendation of the department of infectious diseases antibiotic therapy was escalated to imipenem and transesophageal echocardiography was performed. Endocarditic vegetations could be ruled out. Despite further escalation of the antibiotic regimen, spontaneous pus discharge occurred at the right ankle. A CT scan of the chest as well as the foot and the right ankle with contrast showed new abscess formations in the right thoracic wall between the pectoralis major and minor muscles as well as extensive abscesses in the extensor compartment of the right lower leg. On day 12 after admission, surgical drainage of multiple abscesses was performed, with rapid improvement in general condition and normalized leukocytes. A further six operations were necessary before the patient could be discharged home after 7 weeks of inpatient treatment.

Severe injury to the brachial neurovascular bundle and muscles due to a horse bite: a case report

Introduction

Only a small portion of horse injuries are related to horse bites. In the majority of these occurrences, injuries are minor and self-treated. However, in some cases, the injury may be destructive and limb- and life-threatening. In these instances, the patient requires complex surgery and compound perioperative care.

Case report

We present the case of a 35-year-old Albanian male farm-worker in whom a horse bite caused an extensive lacero-contusive and avulsive wound to the arm. The wound resulted in injury to the brachial artery, brachial and basilic vein, and biceps and brachialis muscles. Nerve structures and underlying humerus remained intact. The initial management of the severe hemorrhagic shock caused by the bleeding at the site of injury included reconstruction of the brachial artery by interposing saphenous graft and that of the brachial vein by termino-terminal anastomosis. Basilic vein was ligated. The wound was extensively debrided, and after a drain was placed in the wound, biceps and brachialis muscles were reconstructed. The patient received several units of red blood cells and fresh frozen plasma before and after surgery, as well as antibiotic, antitetanic, and antirabies prophylaxes. He had several consecutive necrectomies in the following days. However, due to postoperative sepsis and hemorrhagic shock at time of admission, the patient developed acute renal failure, therefore requiring several hemodialysis sessions. After his general and local condition was stabilized, the patient also underwent several reconstructive surgeries.

Conclusion

Horse bites of large extent require a multidisciplinary approach. The composition of the team of physicians needed for treatment varies depending on the degree of the injury and eventual complications. In the case of our patient, emergency department physicians, vascular and plastic surgeons, intensive care specialists, nephrologists, and infective care specialists were involved. In different instances, the inclusion of other specialists may be necessary to save and functionalize the limbs of the patient, or save his/her life.

A Prototype Skin Substitute, Made of Recycled Marine Collagen, Improves the Skin Regeneration of Sheep

Simple Summary

Marine ecosystems are a huge source of unexplored “blue” materials for different applications. The edible part of sea urchin is limited, and the vast majority of the product ends up as waste. Our studies intend to fully recycle wastes from the food industry and reconvert them in high added-value products, as innovative biocompatible skin substitutes for tissue regeneration. The aim of the present work is to apply the pioneering skin substitute in in vivo experimental wounds to test its regenerative potential and compare it, in a future study, to the available commercial membranes produced with collagen of bovine, porcine, and equine origin. Results are encouraging since the skin substitute made with marine collagen reduced inflammation, promoted the deposition of granulation tissue, and enhanced a proper re-epithelialization with the adequate development of skin appendages. In summary, our findings might be of great interest for processing industries and biotech companies which transform waste materials in high-valuable and innovative products for Veterinary advanced applications.

Abstract

Skin wound healing is a complex and dynamic process that aims to restore lesioned tissues. Collagen-based skin substitutes are a promising treatment to promote wound healing by mimicking the native skin structure. Recently, collagen from marine organisms has gained interest as a source for producing biomaterials for skin regenerative strategies. This preliminary study aimed to describe the application of a collagen-based skin-like scaffold (CBSS), manufactured with collagen extracted from sea urchin food waste, to treat experimental skin wounds in a large animal. The wound-healing process was assessed over different time points by the means of clinical, histopathological, and molecular analysis. The CBSS treatment improved wound re-epithelialization along with cell proliferation, gene expression of growth factors (VEGF-A), and development of skin adnexa throughout the healing process. Furthermore, it regulated the gene expression of collagen type I and III, thus enhancing the maturation of the granulation tissue into a mature dermis without any signs of scarring as observed in untreated wounds. The observed results (reduced inflammation, better re-epithelialization, proper development of mature dermis and skin adnexa) suggest that sea urchin-derived CBSS is a promising biomaterial for skin wound healing in a “blue biotechnologies” perspective for animals of Veterinary interest.

Canibacter oris - a fairly unknown pathogenic agent of bite wound infections

Here, we report on the second case of bite wound infection by Canibacter oris. This bacterium belongs to the family of Microbacteriaceae in the order of Microbacterales in the class of Actinobacteria, which are prevalent in the oral flora. Possibly this bacterium has been overlooked until now, because it cannot be recognized by conventional differentiation methods. MALDI-TOF as well as PCR are able to identify this pathogen.

Updates on Rabies virus disease: is evolution toward "Zombie virus" a tangible threat?

Human rabies disease is caused by Rabies Lyssavirus, a virus belonging to Rhabdoviridae family. The more frequent means of contagion is through bites of infected mammals (especially dogs, but also bats, skunks, foxes, raccoons and wolves) which, lacerating the skin, directly inoculate virus-laden saliva into the underlying tissues. Immediately after inoculation, the Rabies virus enters neural axons and migrates along peripheral nerves towards the central nervous system, where it preferentially localizes and injuries neurons of brainstem, thalamus, basal ganglia and spinal cord. After an initial prodromic period, the infection evolves towards two distinct clinical entities, encompassing encephalitic (i.e., “furious”; ~70-80% of cases) and paralytic (i.e., “dumb”; ~20-30% of cases) rabies disease. The former subtype is characterized by fever, hyperactivity, hydrophobia, hypersalivation, deteriorated consciousness, phobic or inspiratory spasms, autonomic stimulation, irritability, up to aggressive behaviours. The current worldwide incidence and mortality of rabies disease are estimated at 0.175×100,000 and 0.153×100,000, respectively. The incidence is higher in Africa and South-East Asia, nearly double in men than in women, with a higher peak in childhood. Mortality remains as high as ~90%. Since patients with encephalitic rabies remind the traditional image of “Zombies”, we need to think out-of-the-box, in that apocalyptic epidemics of mutated Rabies virus may be seen as an imaginable menace for mankind. This would be theoretically possible by either natural or artificial virus engineering, producing viral strains characterized by facilitated human-to-human transmission, faster incubation, enhanced neurotoxicity and predisposition towards developing highly aggressive behaviours. (www.actabiomedica.it)

Epidemiology of Dog Bite Incidents in Chile: Factors Related to the Patterns of Human-Dog Relationship

Dog bites are one of the main public health problems. They produce important consequences for those who suffer them (physical and psychological injuries, secondary infections, sequelae, risk of transmission of zoonoses and surgeries, among others). The objective of this study was to characterize epidemiologically the incidents of bites in Chile and the patterns of human-dog relationship involved. The records analyzed in this article were obtained from bitten patients who attended the main public health facilities in Chile during the period 17 September 2017 and 17 September 2018: In the period studied, 17,299 animal bites were recorded; however, only 7220 (41.74%) cases were analyzed in which the offending species could be identified. Of the bites analyzed, 6533 were caused by dogs (90.48%). Of these, 41.05% were caused by medium-sized dogs. Most bites were caused by dogs of mixed breeds (55.99%), followed by dogs of the German Shepherd breed (8.50%). Most of the dogs that bit were known to the victim (99.95%) and most of the attacks occurred indoors (57.48%). Although dog bite records have improved in Chile, it would be useful to also include background information on the context in which the incident occurred, which would be very useful for developing effective bite prevention programs.

Calculated initial parenteral treatment of bacterial infections: Skin and soft tissue infections

This is the ninth chapter of the guideline "Calculated Parenteral Initial Therapy of Adult Bacterial Disorders - Update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter contains the first German S2k guidelines for bacterial skin and soft tissue infections. They encompass recommendations on diagnosis and treatment of the defined entities erysipelas (caused by beta-hämolytic streptococci), limited superficial cellulitis (S. aureus), severe cellulitis, abscess, complicated skin and soft tissue infections, infections of feet in diabetic patients ("diabetic foot"), necrotizing soft tissue infection and bite injuries.

Zone V Extensor Tendon Repair with a Palmaris Longus Tendon Autograft and Human Umbilical Membrane

Extensor tendon repairs, although common, can be difficult injuries to treat. Their treatment is tailored to the zone of the hand that is affected since varying biomechanical forces are applied to the tendon at each zone. Prompt treatment is necessary to prevent potential complications associated with these injuries. This is particularly true of Zone V extensor tendon injuries, as their mechanism is commonly a highly infectious human bite. We present the case of a human fight bite resulting in a Zone V extensor tendon injury. The delayed presentation of this case resulted in an untreated infection that caused an abscess with associated extensor tendon necrosis and rupture. Given the large gap length between the ends of the tendons, tendon repair was performed using a palmaris longus autograft. Even when these are done in a controlled setting, adhesions are common. The compromised wound bed caused irritation, erosion, and subsequent rupture of the extensor tendon of the hand. In an effort to avoid common complications such as adhesion, the repair was then wrapped with human umbilical membrane (AVIVE® Soft Tissue Membrane, AxoGen Inc., Alachua, FL) to separate adjacent tissue and reduce inflammation. Even without access to formal physical therapy, our patient had excellent functional outcomes at his final follow-up visit. The patient was able to make a loose composite fist, had no extensor lag at the MCP joints, and had extensor lag of 15 degrees at the PIP joints of digits 4-5.

Molecular detection of feline and canine periodontal pathogens

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It is concluded that the feline oral flora is highly diverse than canine oral flora.

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Porphyromonas gingivalis, Prevotella nigrescens and Porphyromonas gulae were the dominant species in cats and dogs.

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T. forsythia, C. ochracea, and C. sputigena in cats and T. forsythia, C. ochracea, C. sputigena T. denticola and, E. corrodens, in dogs showed that the prevalence was lower than 10%. E. corrodens in cats and, P. intermedia, A. actinomycetemcomitans, and C. rectus in dogs were also isolated from the swab samples with less than 30% percentage.

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A balanced diet for cats and dogs should be provided to reduce the formation of residues in the oral flora. Daily rinsing with antiseptic solutions may also be helpful against the development of periodontal pathogens.

Periodontal disease is the most common infectious disease of cats and dogs which are strongly associated with periodontal pathogens. The primary etiologic factor in the formation of periodontal disease is microbial dental plaque accumulation on teeth. In our research, we aimed to investigate the presence of periodontal disease-related bacterial species in dental plaques of cats and dogs. Specimens collected from 50 cats and 51 dogs with periodontal disease examined in terms of periodontal pathogens by polymerase chain reaction (PCR) using primers directed to 16S rRNA and tdpA genes. Our findings indicate the presence of periodontal disease-related pathogens, especially Porphyromonas gingivalis (cats 96%, dogs 88%), Prevotella nigrescens (cats 90%, dogs 57%) and, Porphyromonas gulae (cats 70%, dogs 39%). In addition, the prevalence of Tannerella forthysia (cats 2%, dogs 4%) well-known pathogen in cats and dogs were isolated with an extremely low percentage.

Furthermore, our results suggest that the feline oral cavity microbiota has considerably more diversity than dogs. Consequently, daily oral hygiene practices may become essential for controlling the pathogenic bacteria which have clinical importance and in preventing the propagation of microorganisms in the oral cavity of cats and dogs.

Forecasting delay times in post-exposure prophylaxis to human animal bite injuries in Central Iran: A decision tree analysis

Background and Aim:

Data mining in medical sciences provides countless opportunities for demonstrating hidden patterns of a data set. These patterns can help general physicians and health workers in preventing diseases. This study aimed to forecast delay times in post-exposure prophylaxis (PEP) to human animal bite injuries in central Iran using a decision tree analysis.

Materials and Methods:

The data of 2072 human animal bite cases were collected from Centers for Disease Control and Prevention unit of Qom Provincial Health Center, Iran from January 2017 to December 2018. The information related to animal bite incidents, including the biting animal characteristics and data on the bitten humans, was obtained by investigating the epidemiological survey forms of human animal bites. The decision tree model was applied to forecast the delay time of receiving PEP.

Results:

A delay of more than 48 h in the initiation of PEP was estimated among 12.73% of animal bite victims. The most important variables to predict delay time of receiving PEP were the species of biting animal, time and cause of animal bite occurrences in 24 h a day, respectively. Hence, the model showed a delay in the initiation of PEP if the biting animal was a cattle or, a carnivore, and the time of being bitten was from 7 am to 1 pm, or if the animal was carnivore and the time of being bitten was between 1 and 7 pm, and the cause of animal bite was playing with the animal.

Conclusion:

Based on the findings of the study on different variables affecting the initiation of PEP, the concepts related to animal bite and rabies, including the timely injection of anti-rabies vaccine to prevent rabies, it is a must to educate and train, all the people, especially housewives and students.

Scoping decades of dog evidence: a scoping review of dog bite-related sequelae

OBJECTIVES

There has been considerable literature published focusing on various sequelae to dog bites over the last three decades. Much of the literature has focused on rabies, particularly canine rabies variant, which accounts for the majority of rabies deaths worldwide. This paper describes the complications, the pathogens, and other sequelae resulting from dog bites documented in the literature.

METHODS

This paper used evidence found through a scoping review which charted the published peer-reviewed and non-peer-reviewed gray literature and online information relating to dog bite incidents. Each complication or sequela was additionally assessed from the viewpoint of Canadian Indigenous, rural, and geographically remote communities, which experience a high number of dog bite incidents annually.

SYNTHESIS

Peer-reviewed literature (N = 693; case report, original research, and review articles) provided detailed information on specific pathogens, infections, and diseases of interest, especially rabies. However, in addition to these, the sequelae from dog bites may include moderate to severe injuries that further result in anxiety around dogs or post-traumatic stress disorder (PTSD).

CONCLUSIONS

While a lot of focus in the literature is on rabies as a sequela to dog bites, the impacts of anxiety and PTSD are not as well articulated. Treatment of dog bite injuries may be standardized; however, improved collaborations between diverse health professionals (physicians, veterinarians, counseling services, animal behaviourists, and others) could be of considerable benefit in decreasing the effects of dog bites.

Characteristics and factors associated with post-exposure prophylaxis (PEP) treatment of dog and cat bites among left-behind children: a cross-sectional study in two cities of China

OBJECTIVE

Animal injury is a significant cause of morbidity and mortality worldwide. Dog bites account for tens of millions of injuries annually and the highest risk is among children. However, children may not receive postexposure prophylaxis (PEP) treatment timely and appropriately after rabies exposure. This study aimed to investigate the characteristics and factors associated with PEP treatment of dog and cat bites among left-behind children.

DESIGN

A cross-sectional study using questionnaire was conducted in primary and high schools.

SETTING

Shenzhen and Shantou cities, Guangdong Province, China.

PARTICIPANTS

A total of 9380 participants were included and 2236 of them were with a history of dog and cat bites.

RESULTS

1188 (53.1%) boys and 1048 (46.9%) girls suffered from animal bites. Bitten in holidays was less likely to receive PEP treatment (OR 0.512, 95% CI 0.377 to 0.695) than those bitten in school days. Bitten while being with family (OR 1.418, 95% CI 1.040 to 1.934) and bitten at roadside (OR 1.842, 95% CI 1.297 to 2.171), bitten by unvaccinated animals (OR 1.745, 95% CI 1.246 to 2.443) tended to receive PEP treatment. Compared with unbroken skin, bleeding (OR 1.789, 95% CI 1.165 to 2.745) and laceration (OR 3.834, 95% CI 2.310 to 6.366) were showed as treatment prompting factors.

CONCLUSIONS

Bitten in holidays was found as a risk factor of receiving PEP treatment of animal bites. Certain measures should be taken to raise left-behind children's awareness of receiving PEP treatment timely and appropriately after dog and cat bites.

[Surgical treatment of bites]

OBJECTIVE

Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons.

INDICATIONS

Acute traumatic and late presented bite injuries.

CONTRAINDICATIONS

General contraindication for anesthesia or surgery.

SURGICAL TECHNIQUE

Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects.

POSTOPERATIVE MANAGEMENT

Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery.

RESULTS

Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.

Encapsulation of Curcumin Nanoparticles with MMP9-Responsive and Thermos-Sensitive Hydrogel Improves Diabetic Wound Healing

Impaired wound healing in diabetics usually leads to life-threatening complications. To develop a system for fastening skin wound healing efficiently and safely in diabetics, thermos-sensitive hydrogel containing the nanodrug, loaded in the form of gelatin microspheres (GMs), was designed to deliver curcumin (Cur) as a therapeutic drug. Cur is a naturally existing polyphenolic compound with a broad range of biological functions useful for potential therapies. Because Cur molecule has weakness in both bioavailability and in vivo stability, delivery of Cur requires assistance from other molecules to act as carrier vehicles in a sustained manner for therapeutic use. At first, self-assembly of Cur nanoparticles (CNPs) was done to improve bioavailability. The CNPs were further enclosed into GMs for responding to the matrix metalloproteinases (MMPs) that usually overexpress at diabetic nonhealing wound sites. The GMs containing CNPs were loaded into the thermos-sensitive hydrogel and were finally proved for the capacity of specially induced drug release at the wound bed, which promoted the efficacy in healing the standardized skin wounds in streptozotocin-induced diabetic mice. Our results indicated that the successfully developed CNP delivery system had the capacity to significantly promote skin wound healing, which suggested that it could have the potential to become a wound dressing with the properties of antioxidants and promotions of cell migration.

Rat-bites of an epidemic proportion in Peshawar vale; a GIS based approach in risk assessment

Contemporary studies demonstrate that rodent bites do not occur frequently. However, a huge number of cases were reported from Peshawar vale, Pakistan during 2016. Two species, the local black rat Rattus rattus (Linnaeus, 1758) and the invasive brown rat Rattus norvegicus (Berkenhout, 1769) might be the suspected cause. Several studies indicated the invasion of brown rats into Pakistan presumably via port city of Karachi. In this study, we modeled geospatial distribution of rodent bites for risk assessment in the region. Bite cases reported to tertiary care lady reading hospital were monitored from January 1 to August 31, 2016. Among 1747 cases, statistically informative data (n = 1295) was used for analyses. MaxEnt algorithm was employed for geospatial modeling, taking into account various environmental variables (temperature, precipitation, humidity, and elevation) and anthropogenic factors (human population density, distance from roads, distance from water channels, and land use/land cover). MaxEnt results revealed that urban slums (84.5%) are at highest risk followed by croplands (10.9%) and shrublands (2.7%). Anthropogenic factors affecting incidence of rodent bites included host density (contribution: 34.7), distance from water channels (3.2), land use/land cover (2.8), and distance from roads (2). Most of the cases occurred within a radius of 0.3 km from roads and 5 km from water channels. Rodent bite incidence is currently at its peak in Peshawar vale. Factors significantly affecting rodents' bite activity and their distribution and dispersal include urbanization, distance from roads, and water channels. Further studies are needed to determine the impact of invasion by brown rat on bite incidence.

A Comparative Study of Dog- and Cat-Induced Injury on Incidence and Risk Factors among Children

Background: Millions of people are bitten by animals each year, with approximately 90% of the injuries being caused by dogs and cats. However, few studies focus on risk factors of dog- and cat-induced injury in China. Therefore, the objective of this study was to investigate the rate of dog- and cat-induced injury and its potential risk factors. Methods: The data were from a population-based cross-sectional study conducted in 2015, with a sample of 9380 children 6-19 years of age from two cities, Shenzhen (large city) and Shantou (mid-sized city), in southern China. Multivariate logistic regression models were used to identify the risk factors of injury by dogs and cats. Results: The total rates of dog and cat-induced injury were 15.1% and 8.7% during the lifetime, and 3.4% and 1.7% during the past year, respectively. Dog bites mostly occurred in the dog's residence (49.4%). Cat scratches were more likely to be inflicted by one's own cat (47.5%). Children living in suburban and island county had 2.83 times and 2.53 times more dog-related injuries than central urban children, respectively. After stratification by cities, injuries in Shantou were correlated with non-single child families (OR (odds ratios), 1.46; 95% CI (95% confidence interval), 1.09-1.96) and raising cats (OR, 5.34; 95% CI, 3.88-7.35). Those who disliked animals (OR, 0.62; 95% CI, 0.45-0.88) or had good academic performance (OR, 0.46; 95% CI, 0.35-0.60) had lower risk for injury. Injuries in Shenzhen were related to the mother's educational level (OR, 1.51; 95% CI, 1.11-2.07) and mother being a migrant worker (OR, 2.10; 95% CI, 1.12-3.94). Conclusions: Family factors were important to predict dog- and cat-induced injury among children from Shenzhen, and personal factors were closely associated with injury among children form Shantou.

[General principles of wound management in emergency departments]

Wound management is one of the major tasks in emergency departments. The surrounding intact skin but not the wound itself should be disinfected before starting definitive wound treatment. Hair should first be removed by clipping to 1-2 mm above the skin with scissors or clippers as shaving the area with a razor damages the hair follicles and increases the risk of wound infections. Administration of local anesthetics should be performed directly through the exposed edges of the wound. After wound examination, irrigation is performed with Ringer's solution, normal saline or distilled water. The next step is débridement of contaminated and devitalized tissue. There are several wound closure techniques available, including adhesive tapes, staples, tissue adhesives and numerous forms of sutures. Management of specific wounds requires particular strategies. A bleeding control problem frequently occurs with scalp lacerations. Superficial scalp lacerations can be closed by alternative wound closure methods, for example by twisting and fixing hair and the use of tissue adhesives, i.e. hair apposition technique (HAT). For strongly bleeding lacerations of the scalp, the epicranial aponeurosis should be incorporated into the hemostasis. Aftercare varies depending on both the characteristics of the wound and those of the patient and includes adequate analgesia as well as minimizing the risk of infection. Sufficient wound aftercare starts with the treating physician informing the patient about the course of events, potential complications and providing relevant instructions.