Correction of post burns contracture of wrist with Ilizarov method

A case of severe post burns contracture of the wrist, of 43 years duration resulting in recurrent ulceration of the skin was successfully treated by gradual distraction using the Ilizarov method. This method is superior to plaster of Paris cast and is more versatile than other forms of external fixation.

Hospital-made diet versus commercial supplement in postburn nutritional support

Nutritional support is an important aspect of the management of burn patients. Nutrition supplementation can be achieved either by 'hospital-made' or 'commercial' diets. Commercial diets are efficacious but expensive and sometimes not easily available. This study was undertaken to compare the efficacy and tolerance of a hospital-made diet with a commercial diet. Twenty patients with burns ranging from 20-50 per cent TBSA were studied to compare the efficacy and tolerance of the 'hospital-made' diet with 'commercial' preparations. Patients were divided into two groups of 10 each and randomised within each group to receive either a hospital-made diet (five patients) or a commercial diet (five patients). Efficacy of diet was assessed by evaluation of nutritional status, graft take, number of surgical procedures and duration of hospital stay. Tolerance was assessed by recording side effects such as nausea, vomiting, abdominal distention and diarrhoea. Both diets were well tolerated by all patients. There was no significant difference in nutritional status, number of surgical procedures, percentage of graft take and duration of hospital stay on either diet, suggesting that hospital-made diets are similar in efficacy and tolerance but cheaper and more easily available. They are a good alternative to 'commercial' diets, especially in poor patients.

Intradialytic dobutamine therapy in maintenance hemodialysis patients with persistent hypotension

Intradialysis hypotension is a common problem, especially in patients with poor left-ventricular function. We studied 6 patients who were on maintenance hemodialysis with left-ventricular ejection fraction of <40%, whose dialysis sessions were often complicated with severe hypotension (systolic blood pressure <90 mm Hg). Dobutamine infusion during dialysis significantly reduced the number of hypotensive episodes, increased left-ventricular ejection fraction, and decreased the number of emergency admissions to the hospital.

Combined therapeutic use of umbilical cord blood serum and amniotic membrane in diabetic wounds

Diabetic wounds are hard-to-heal due to complex multifactorial dysregulation within the micro-environment, necessitating the development of novel regenerative approaches to stimulate healing. This study investigated whether the combined therapeutic application of two novel cellular tissue products, namely a decellularized collagen-rich amniotic membrane (AmR) and growth factor-rich umbilical cord blood serum (UCBS) could have a positive synergistic effect on long-term healing outcomes by stimulating both superficial wound closure and wound bed regeneration. Full thickness excisional wounds were induced on obese diabetic mice (B6.Cg-lepob/J, ob/ob, n = 23) and treated with either: 1) Standard wound care (control); 2) UCBS; 3) AmR or 4) UCBS + AmR. Macroscopic wound closure was assessed on days 0, 3, 7, 10 and 14 post wounding. To determine the potential impact on wound recurrence, endpoint analysis was performed to determine both the overall quality of healing histologically as well as the molecular state of the wounds on day 14 via proteomic analysis. The data demonstrated the presence of both healers and non-healers. Re-epithelization took place in the healers of all treatment groups, but underlying tissue regeneration was far more pronounced following application of the combined treatment (UCBS + AmR), suggesting improved quality of healing and potentially a reduced change of recurrence long term. In non-healers, wounds failed to heal due to excessive slough formation and a reduction in LTB4 expression, suggesting impaired antimicrobial activity. Care should thus be taken since the cellular tissue product therapy could pose an increased risk for infection in some patients.

The impact of obesity on the cellular and molecular pathophysiology of COVID-19

Emerging evidence reveals a strong association between COVID-19 and obesity in terms of disease severity, need for hospitalisation and risk of mortality. In this review, we discuss cellular and molecular mechanisms potentially contributing to the pathophysiology of COVID-19 in obese patients. Understanding the relationship between COVID-19 and obesity is pertinent for the clinical management of these patients.