Efficacy and satisfaction of surgical treatment for hidradenitis suppurativa

BACKGROUND

Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative.

OBJECTIVES

To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence.

METHODS

We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (<1 cm from the scar), and recurrence-associated factors were analysed by univariate then multivariate logistic regression, estimating odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 75 patients [median age 31.4 years (range 16-71); 36 females], corresponding to 115 interventions were included. The Hurley score at surgery was III for 70 (60%) patients. In total, 61/115 (53%) interventions involved wide excision and 50 (43%) limited local excision. The localizations were axillary folds (n = 46; 40%), buttocks (n = 15, 13%), genital area (n = 13; 11%), perineal area (n = 12; 10%) and inguinal folds (n = 18; 16%). We observed 11 (10%) complications and 40 (35%) recurrences. On multivariate analysis, probability of recurrence was associated with only one-stage surgical closure [OR 3.2 (95% CI 1.4-7.3), P = 0.005]. Overall, 44 (52%) patients were completely satisfied and 22 (26%) partially satisfied, and most (81%) considered the surgery the best treatment.

CONCLUSIONS

Hidradenitis suppurativa recurrence in our study was 35% and associated with one-stage surgical closures, but two-thirds of patients were satisfied with surgical treatment and would recommend surgery.

Wound healing of cutaneous substance losses based on infectious, inflammatory and traumatic skin disorders: The experience of a center

INTRODUCTION

There is no reference available concerning the standard healing time based on dermatological diseases responsible for cutaneous substance losses. The aim of our study was to assess the healing time after surgical debridement of necrotizing fasciitis (NF), hidradenitis suppurativa (HS) and skin necrosis due to trauma (SNT) based on multiples existing co-morbidities among these patients to provide surgeons with accurate scientific data in order to inform and educate patients and nurses who are practicing care under the supervision of the surgeon.

MATERIALS AND METHODS

This was a retrospective study. The primary endpoint was the time for complete wound healing, which was calculated from the time of the last surgical procedure to the complete wound healing corresponding to the time of complete reepithelialization, when daily dressings were no longer needed.

RESULTS

A total of 107 patients were included. The mean time for complete wound healing was 64.94±31.55 days in patients with NF, 45.70±21.40 days in patients with SNT and 75.02±26.41 days in patients with HS (SNT versus NF, P=0.004** and SNT versus HS, P<0.0001**).

CONCLUSION

The mean time for complete wound healing was 64.94 days in patients with NF, 45.70 days in patients with SNT, 75.02 days in patients with HS. This study can be considered as a referential based on the experience of a reference centre for these 3 pathologies (NF, HS, and SNT) whose aim is to inform plastic surgeons in order to anticipate the management or educate the patient.

Dietary Strategies to Combat Deficiencies of Iron, Zinc, and Vitamin A in Developing Countries: Development, Implementation, Monitoring, and Evaluation

In many developing countries, staple diets are plant-based and consumption of animal products is low. As a result, the intake and bioavailability of iron, zinc, and vitamin A are often poor. Deficiencies of these micronutrients can be prevented by using dietary diversification and modification, a strategy involving changes in food production practices, food selection patterns, and traditional household methods for preparing and processing indigenous foods. Strategies at the food production level include the use of fertilizers, plant breeding, and genetic engineering to enhance the content and bioavailability of micronutrients in plant-based staples and increase the yield of indigenous edible wild plants. Household strategies involve small-livestock production, aquaculture, gardening projects, and changes in certain food preparation and processing practices designed to alter the content of absorption modifiers in the diet, such as soaking, germination, fermentation, and enrichment. This review also describes how these household strategies can best be incorporated into existing food consumption patterns, and how their impact on the nutrient adequacy of the diets can be assessed. the steps necessary to test the acceptability of the modified recipes, to identify potential barriers to their adoption, and to implement them in the community are discussed, using an example from rural Malawi. Finally, methods of monitoring the progress and evaluating the impact of the dietary strategies in short- and long-term studies are included.

Transmission electron microscopy and X-Ray diffraction analysis of aluminum-induced crystallization of amorphous silicon in alpha-Si:H/Al and Al/alpha-Si:H structures

Solid phase crystallization of plasma-enhanced chemical-vapor-deposited (PECVD) amorphous silicon (alpha-Si:H) in alpha-Si:H/Al and Al/alpha-Si:H structures has been investigated using transmission electron microscopy (TEM) and X-ray diffraction (XRD). Radiative heating has been used to anneal films deposited on carbon-coated nickel (Ni) grids at temperatures between 200 and 400 degrees C for TEM studies. alpha-Si:H films were deposited on c-Si substrates using high vacuum (HV) PECVD for the XRD studies. TEM studies show that crystallization of alpha-Si:H occurs at 200 degrees C when Al film is deposited on top of the alpha-Si:H film. Similar behavior was observed in the XRD studies. In the case of alpha-Si:H deposited on top of Al films, the crystallization could not be observed at 400 degrees C by TEM and even up to 500 degrees C as seen by XRD.

Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study

OBJECTIVE

To introduce practices for improving complementary feeding and evaluate their adoption and association with improved dietary intakes.

DESIGN

A quasiexperimental pilot study comparing dietary intakes from complementary foods among three intervention communities and one control community before and after the intervention, and adoption of new complementary feeding practices among intervention communities following the intervention.

SETTING

Rural subsistence communities in southern Malawi, Central Africa.

SUBJECTS

Mothers and their children aged 6 to 23 months receiving complementary foods.

INTERVENTIONS

A participatory, nutrition education intervention based on four locally adapted lessons for complementary feeding practices designed to increase: (i) total complementary food intake; (ii) energy and nutrient density of the complementary diet, and; (iii) iron and zinc bioavailability of the complementary diet.

RESULTS

Adoption rates for the four practices ranged from 25% for preparation of enriched porridges, to 10% for preparing soaked, pounded maize. The amount of complementary foods (g/day) and intakes of energy, animal protein, niacin, riboflavin, calcium, iron, and zinc, but not vitamin A, were significantly greater (P<0.05) in the intervention compared to control group, as were the energy, iron, and riboflavin density, and the estimated amount of bioavailable iron and zinc.

CONCLUSIONS

Several intervention practices were well accepted and adopted and were associated with improved adequacy of energy and nutrient intakes from the complementary diet. Such improvements were attributed mainly to greater total intakes and, to a lesser extent, enhanced dietary quality of the complementary foods.

Complementary feeding practices and dietary intakes from complementary foods amongst weanlings in rural Malawi

OBJECTIVE

The objectives of this study were to estimate the quantity and nutritive quality of the complementary diet in rural Malawi, and to identify feeding practices, nutrients and dietary modifiers of iron and zinc bioavailability that may limit the quality of the diet.

DESIGN

This cross-sectional study design included an anthropometric survey, a feeding practices questionnaire, and an interactive, 24 h recall dietary data survey.

SETTING

Four rural villages in Balaka district, southern Malawi.

SUBJECTS

Mothers resident in the study communities with breastfed children aged up to 24 months were eligible.

RESULTS

Stunting was prevalent among these weanlings. Maize was the predominant food source, with limited contribution of animal foods. Deficits in dietary energy and several nutrients were found when compared to estimated needs. When expressed per kg body weight, energy intakes appeared adequate. The bioavailability of zinc was low due to a high phytate:zinc molar ratio. Iron bioavailability was also low due to low intake of absorption enhancers such as meat/fish/poultry protein and ascorbic acid. Dietary quality was poorest for 6 to 8-month-old infants.

CONCLUSIONS

Iron, zinc and calcium were the most limiting nutrients to the quality of the diet, partly exacerbated by the poor bioavailability of iron and zinc. Increased total intake and bioavailability of iron and zinc would improve the complementary diets.

SPONSORSHIP

This study was funded by the Thrasher Research Fund, Salt Lake City, Utah, USA.

Dietary diversification/modification strategies to enhance micronutrient content and bioavailability of diets in developing countries

Both cereal staples and household diets can be manipulated to enhance the content of micronutrients and/or alter the levels of absorption modifiers to improve micronutrient bioavailability. Strategies described range from plant breeding, use of fertilizers and genetic engineering to changes in food preparation and processing methods at the household level involving soaking, fermentation and germination. The impact of five household strategies designed to enhance the content and bioavailability of iron, zinc and calcium in a representative daily menu for rural Malawian preschool children has been calculated using food composition data. In the five strategies, relishes based on small dried fish replaced plant-based relishes, maize-based porridges prepared with maize flour soaked to reduce its hexa (IP-6)- and penta (IP-5)-inositol phosphate content replaced conventional porridges; and a pumpkin-leaf relish replaced sweet potato to increase the retinol content of the daily menu. Comparison of the calculated energy, nutrient, and phytate content, and [phytate]:[zinc] molar ratios of the five modified menus compared with the unmodified menu emphasizes that to ensure that the estimated requirements for iron and zinc are met, the optimal strategy includes dried fish relish twice daily together with porridges prepared using soaked (or fermented) maize flour to reduce their hexa- and penta-inositol phosphate content. Implementation of these household strategies has the potential to increase the bioavailability of iron and zinc in rural Malawian diets from low to high.

Identifying populations at risk of zinc deficiency: the use of supplementation trials

Zinc supplementation trials assessing the response of growth and immunity have assisted in identifying populations at risk of zinc deficiency and the factors that contribute. A recent trial in Ethiopia demonstrated a high risk of zinc deficiency among young children, particularly among those who were stunted.

A home-based method to reduce phytate content and increase zinc bioavailability in maize-based complementary diets

This study aimed to develop and assess the feasibility of a home-based method to reduce the phytate content of maize and improve zinc bioavailability from maize-based complementary diets in rural Malawi. A method of extracting phytate through the soaking of pounded maize was developed, and found to reduce phytate content to 49% of unrefined maize. An educational program was used to teach the processing method to mothers of children receiving complementary foods in rural Malawian communities. Samples of maize flour prepared by this process by participants were collected and analysed for phytate and zinc content. Of these, 70% of samples were found to be adequately prepared; mean phytate content of these samples was 48% of unprocessed, unrefined maize flour controls. Most participants found the cooked product to have an acceptable taste (99%) and texture (68%), and felt the processing method took little or no extra time (86%) and was culturally acceptable (96%). The phytate and zinc content of the processed maize flour samples analysed from community prepared samples was substituted into the dietary analysis of complementary foods for 9- to 11-month-old children (n = 31). The bioavailability of zinc from the complementary diet would predict an increase from low (24%) to moderate (33%) levels.

Assessment of home-based processing methods to reduce the phytate content and phytate/zinc molar ratio of white maize (Zea mays)

Various methods of processing maize suitable for household use in rural Malawi, Central Africa, were investigated for their ability to reduce its phytate content and phytate/zinc molar ratio. These methods included fermentation, germination, and soaking. Penta- and hexainositol phosphates were measured by HPLC, and zinc was measured by atomic absorption spectrophotometry. Natural lactic fermentation of maize flour slurries resulted in 88% phytate retention compared to unprocessed, unrefined maize flour porridges, whereas lower phytate retention was observed when a starter culture (61%) or germinated flour (71%) was also used. Fermentation of cooked maize flour porridges with germinated flour added resulted in 54-85% retention of phytate compared to controls. Soaking maize flour or pounded maize and decanting excess water resulted in 43 and 49% retention of phytate, respectively. The latter soaking procedures were simple and effective and were suitable for household use in rural Malawian communities.

Dietary phytate reduction improves zinc absorption in Malawian children recovering from tuberculosis but not in well children

High dietary phytate content that compromises zinc nutriture is thought to be a major problem among children of the developing world. Zinc stable isotope techniques permit the quantitative assessment of the effect of phytate reduction on zinc homeostasis. We tested the hypothesis that zinc absorption would be increased in Malawian children fed a reduced-phytate corn-plus-soy diet compared with a standard high phytate diet. Twenty-three children hospitalized in Blantyre, Malawi, were enrolled. Children were selected from those recovering from tuberculosis and from well children (those with minor injuries, those awaiting elective surgery or healthy siblings). Children received a diet of corn-plus-soy porridge (either low phytate or high phytate) for a period of 3-7 d and then participated in a zinc stable isotope study. The study included the administration of oral and intravenous zinc stable isotopes and 7-d collections of urine and stool. The diet was maintained throughout the duration of specimen collection. Zinc isotopic enrichments in urine and stool were measured, and zinc fractional absorption, total zinc absorption, endogenous fecal zinc, net zinc retention and size of the exchangeable zinc pool were calculated. Among the 14 children recovering from tuberculosis, dietary phytate reduction resulted in higher fractional absorption (0.41 +/- 0.14 versus 0.24 +/- 0.09, mean +/- SD, P: < 0.05) and total zinc absorption (169 +/- 55 versus 100 +/- 46 microg/(kg. d), P: < 0.05). No effect of phytate reduction was seen in the well children (n = 9). Phytate reduction did not decrease the absolute endogenous fecal zinc, but it did decrease it relative to total absorbed zinc. These preliminary results indicate that phytate reduction may be beneficial in improving zinc nutriture in groups with increased zinc requirements who consume a cereal-based diet.