The use of Nexobridtm in debriding chronic ulcers: a preliminary observational study

Nexobrid is a highly selective enzymatic debriding agent used in the acute management of burns to perform escharectomy. From October 2016 to April 2017, we treated 6 patients affected with lower limb chronic ulcers of different etiologies with Nexobrid in order to perform eschar removal by enzymatic debridement. For all patients, a dosage of Nexobrid, calculated as 2gr per 1% TBSA, was applied in a 2-3 mm thick uniform layer on the ulcer eschar and fibrin tissue and left for 4 hours, covered with an occlusive dressing. Patients were assessed in terms of ulcer cleansing 24 hours and 7 days post Nexobrid debridement, by wound bed score (WBS) and % of remaining necrotic tissue. A patient pain VAS was also recorded at 24 hours and 7 days post debridement. Adverse events at these time points were also noted. The results documented a complete removal of necrotic tissue in a time frame of 4 hours. At 24 hours, all lesions were completely debrided. At 7 days, there was a partial recurrence of necrotic tissue, as also documented by decreased WBS. All patients reported none to mild pain, and no adverse events were noted, except for mild erythema along the edges of the lesion on healthy skin in one case. This is a preliminary observation. Optimal dosage and application of Nexobrid in this indication needs to be validated by further controlled data.

Influence of fresh forage-based diets and αs₁-casein (CSN1S1) genotype on nutrient intake and productive, metabolic, and hormonal responses in milking goats

Polymorphism at the αS1-casein locus (CSN1S1) in goats influences several milk production traits. Milk from goats carrying strong alleles, which are associated with high αS1-casein (αS1-CN) synthesis, has higher fat and casein contents, longer coagulation time and higher curd firmness than milk from goats with weak alleles linked to low αS1-CN content. Nutrition also affects these milk properties; therefore, it is important to better understand the interaction between dietary characteristics and the CSN1S1 genotype in goats. This study aimed to investigate the effect of fresh forage based diet or energy supplement on feeding behavior, milk production, and metabolic and hormonal parameters of Girgentana goats with different genotypes at CSN1S1 loci. From a group of goats genotyped by PCR at the DNA level, 12 were selected because they had the same genotype for αS2-CN, β-CN, and κ-CN but a different genotype for αS1-CN: 6 were homozygous for strong alleles at the CSN1S1 loci (AA) and 6 were heterozygous for a weak allele (AF). Goats of each genotype were allocated to 3 subgroups and fed 3 diets ad libitum in a 3×3 Latin square design. The diets were sulla (Hedysarum coronarium L.) fresh forage, sulla fresh forage plus 800 g/d of barley meal (SFB), and mixed hay plus 800 g/d of barley meal (MHB). Diet had a stronger effect than CSN1S1 genotype. The SFB diet led to the highest energy intake, dry matter (DM) digestibility, and milk yield. The fresh forage diets (SFF and SFB) increased DM and crude protein (CP) intake, CP digestibility, and milk CN compared with the MHB diet. The diets supplemented with energy (SFB, MHB) reduced milk fat and urea, improved CP utilization for casein synthesis, and limited body fat mobilization, in accordance with a lower level of nonesterified fatty acids and higher levels of glucose and IGF-1. With regard to CSN1S1 genotype, AA goats showed higher CP digestibility and lower free thyroxine hormone and cholesterol levels than AF goats. Significant diet × genotype interactions indicated how AA goats, compared with AF goats, showed higher DM digestibility and milk yield when fed the SFB diet, which had more energy. A reduction in free triiodothyronine hormone occurred in AF goats fed the MHB diet, whereas no differences were observed in AA goats. These results demonstrate how goats with a higher capacity for αS1-CN synthesis exhibit more efficient energy and protein utilization, evident at the digestive level, and better productive responses to high-nutrition diets.

[Gloves as medical devices or individual protection devices: current regulations and correct use in hospital environments]

BACKGROUND

Hospital work consists of the care and assistance of patients, who therefore constitute another group of individuals besides the workers, which is a completely different situation compared to other workplaces in manufacturing industries.

OBJECTIVES

Health professionals must know how to use the right devices to protect both the patients and themselves. In the case of protection of the hands, health professionals must also know when to use gloves as "individual protection gloves" and when to use gloves as "medical devices", and comply with both Italian and European Community regulations.

METHODS AND RESULTS

The Hospital of Vimercate (Milan) has drawn up technicalprocedures regarding the various types of gloves used in hospitals, which provide health care workers with accurate information on regulations and protocols, prevention guidelines, safety management recommendations, purchasing specifications, quality controls, correct uses of gloves and devices.

A trial to assess the efficacy and tolerability of Hyalofill-F in non-healing venous leg ulcers

OBJECTIVE

This single-centre, open, uncontrolled pilot clinical trial set out to assess the efficacy and tolerability of Hyalofill-F (a partial benzyl ester derivative of hyaluronan), used in combination with compression bandaging, in the treatment of venous leg ulcers.

METHOD

The 20 patients enrolled into the study had venous insufficiency and a leg ulcer that had been refractory to treatment for one month. Treatment was continued for eight weeks, with weekly assessments.

RESULTS

During the study period four of the patients' ulcers healed completely. An average wound area reduction of 53.5% was seen in the ulcers that did not heal. Differences in ulcer area and ulcer depth between the initial and final visit were significant (p < 0.01, p = 0.03). The average healing rate (cm2/week reduction) was 1.26 +/- 1.7 (standard deviation). A calculated prognostic index was used to identify patients at high risk of a poor response to compression therapy (10% probability of wound closure at 120 weeks). These patients demonstrated a mean 63% decrease in wound area after eight weeks of treatment with Hyalofill-F plus compression bandaging. All wounds showed a positive response in terms of granulation-tissue formation. The comfort of the dressing was described as excellent.

CONCLUSION

The hyaluronan derivative showed promising results in initiating the healing process in chronic venous ulcers. It was found to be well tolerated and safe to use. However, further clinical trials should be performed involving a control group to verify these data.

DECLARATION OF INTEREST

This study was sponsored by Fidia Advanced Biopolymers, Italy.

[Comparison of a combination of fentanyl and alfentanil with propofol in brief surgery]

We studied 96 patients undergoing short gynecological procedures. Anaesthesia has been induced with fentanyl 1.5 micrograms/kg (45 patients) or alfentanil micrograms /kg (51 patients) and a hypnotic dose of propofol, and maintained with 70% N2O via facial mask. We observed a better and more rapid control of surgical analgesia with alfentanil, and an earlier recovery of postoperative psychophysical functions. Post-induction apnea has been more frequent and prolonged in the alfentanil group, but no difference in the time necessary to recover an adequate ventilation has been observed between the two groups. Alfentanil anaesthesia determined a more marked intraoperative bradycardia. By virtue of the speed of onset and the short duration of action, alfentanil is a suitable anaesthetic agent for short surgical procedures, particularly in day-stay patients.

[Anesthesia for shoulder surgery. Comparison of anesthesiologic problems and technics]

We evaluated the ability of general, regional (interscalene block) and balanced anaesthesia (interscalene block supplemented by general anaesthesia) to manage the problems of shoulder surgery. Our results show that general anaesthesia is not adequate. Interscalene block provides intra and postoperative analgesia, allows an early realization of the postoperative rehabilitation programme and quickens the recovery of shoulder function. Therefore, interscalene block should routinely be performed. The positions of patient and surgeons cause the main disadvantages of anaesthesia with interscalene block alone, ad the control of airway of sedated patients is difficult and performing general anaesthesia in case of insufficient analgesia may be troublesome. Balanced anaesthesia, as compared to regional block alone, allows a safer control of respiration and an easier control of surgical analgesia.

[Muscular rigidity caused by alfentanil: prevention]

We studied three groups of 30 patients each, undergoing minor orthopaedic surgery, anaesthetized with alfentanil (30 micrograms/kg bolus followed by an infusion of 0.3 micrograms/kg/min), thiopental 3 mg/kg and 70% N2O via facial mask. Patients in group I were treated, three minutes before induction, with vecuronium 0.02 mg/kg i.v., while those in group II were premedicated with diazepam 0.15 mg/kg i.m. 30-45 minutes before induction. Group III served as control. Muscular rigidity was evaluated clinically with a subjective score based on a scale of 0 (no rigidity) to 3 (severe rigidity). Diazepam did not give significant protection from muscular rigidity. Vecuronium administration did not significantly reduced the number of patients who became rigid, but significantly decreased the incidence of severe rigidity (p less than 0.005), the mean rigidity score (p less than 0.05) and the incidence of rigidity at the induction of anaesthesia (p less than 0.0005). We also observed a progressively increasing incidence of rigidity with increasing age (not significantly) and body weight (p less than 0.05 total rigidity, p less than 0.01 severe rigidity).