Wound bed preparation with hypochlorous acid oxidising solution and standard of care: a prospective case series

2021 ◽  
Vol 30 (10) ◽  
pp. 830-838
Author(s):  
Elia Ricci ◽  
Monica Pittarello
Keyword(s):  
Hypochlorous Acid ◽  
Conflicts Of Interest ◽  
Case Series ◽  
Standard Of Care ◽  
Oxidation Potential ◽  
Inclusion Criteria ◽  
Pain Scores ◽  
High Reduction ◽  
Prospective Case Series ◽  
Wound Bed Preparation

Objective: This prospective case series aims to evaluate the clinical impact of a hypochlorous acid oxidising solution (AOS) in association with usual standard of care (SoC) on wound bed preparation (WBP) in patients with hard-to-heal ulcers of various aetiologies. The AOS (Nexodyn, APR Applied Pharma Research S.A., Switzerland) comprises three main features: highly pure and stabilised hypochlorous acid, acidic pH and high reduction–oxidation potential. Method: Between February 2015 and February 2017, patients who met the inclusion criteria were treated with AOS and usual SoC. Data collection ran for 70 days: T0–T70. A baseline assessment was undertaken at T0; parameters assessed at fortnightly visits included: WBP score, area and depth of ulcer, duration, pain, Bates–Jensen score and infection status. Results: A total of 60 patients took part in the study. By T70, 68.3% of wounds had healed or improved and a significant wound size reduction of 21% was observed (p<0.001), despite a mean wound duration of 20.6 months. All wounds were free of local infection and cellulitis; 10% were colonised. WBP scores improved, while Bates–Jensen and pain scores fell significantly over time. Conclusion: This evaluation suggests that AOS might represent a valuable therapeutic addition for an optimal WBP in the routine management of hard-to-heal ulcers of different aetiologies. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest.

Hard-to-heal ulcers treated with hypochlorous acid oxidising solution and standard of care: a 32-week follow-up

2021 ◽  
Vol 30 (10) ◽  
pp. 840-844
Author(s):  
Elia Ricci ◽  
Monica Pittarello
Keyword(s):  
Hypochlorous Acid ◽  
Treatment Time ◽  
Conflicts Of Interest ◽  
Clinical Performance ◽  
Case Series ◽  
Standard Of Care ◽  
Primary Study ◽  
Total Treatment Time ◽  
Prospective Case Series

Objective: Immediately following a two-year prospective case series in which the wounds of 60 patients with hard-to-heal ulcers were treated with a hypochlorous acid oxidising solution (AOS) in addition to standard of care (SoC) for 70 days (T0–T70), a subset of 31 patients (51.7%) whose wounds had not fully healed by T70 opted to continue with treatment for a further 22 weeks (days T70–T224, a total treatment time of 32 weeks (224 days). The objective was to provide long-term evidence on the clinical performance and safety of AOS when used in association with the usual SoC in patients with stalled, hard-to-heal ulcers of various aetiologies. Method: As per the main study, wounds were formally assessed by the study lead at 28 days (±14 days, depending on patient attendance). Parameters assessed at fortnightly visits included area, depth and duration of ulcer; pain; wound bed preparation (WBP) score; and infection status. Wounds were managed in accordance with the SoC protocol. Results: By T224, 35.5% (n=11) of wounds healed completely and 83.9% showed some types of improvement. All wounds were free of infection and colonisation, the WBP score improved (100% A1–A2 at T196), and pain scores fell. Use of AOS in combination with several types of dressing (SoC) for such a long period confirmed a good safety profile. Conclusion: This follow-up evaluation, coupled with the primary study, suggests that AOS might represent a valuable therapeutic addition for the management of hard-to-heal ulcers for long periods of treatment. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest.

Prospective case series on the use of peripheral nerve stimulation for focal mononeuropathy treatment

2019 ◽  
Vol 9 (6) ◽  
pp. 551-558 ◽  
Author(s):  
Jessica Oswald ◽  
Varun Shahi ◽  
Krishnan V Chakravarthy
Keyword(s):  
Peripheral Nerve ◽  
Case Series ◽  
Suprascapular Nerve ◽  
Intercostal Nerve ◽  
Nerve Stimulator ◽  
Patient Case ◽  
Peripheral Nerve Stimulator ◽  
Pain Scores ◽  
Early Results ◽  
Prospective Case Series

Aim: This case series looks at outcomes in 39 patients implanted using the Bioness Stimrouter system on various isolated mononeuropathies. Patients & methods: A case series of 39 patients with a total of 42 implants were enrolled starting August 2017 at various pain management centers. Results: Of 39 patients studied, 78% of the participants noticed an improvement in their pain. There was a 71% reduction in pain scores with the average preprocedure score of 8 improving to 2 post-implant. Participants noted on average a 72% improvement in activity with the greatest observed in the brachial plexus (80%) and suprascapular nerve (80%) and smallest in the intercostal nerve (40%). Approximately 89% of those implanted with a peripheral nerve stimulator experienced a greater than 50% reduction in opioid consumption. Conclusion: Peripheral nerve stimulators are a new, minimally invasive neuromodulation modality that shows promising early results in our 39-patient case series.

scholarly journals Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096068
Author(s):  
Laylaa Ramos ◽  
Matthew J. Kraeutler ◽  
Eric Marty ◽  
K. Linnea Welton ◽  
Tigran Garabekyan ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Early Postoperative Period ◽  
Activity Level ◽  
Pain Level ◽  
Preoperative Pain ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Prospective Case Series

Background: Despite the rapid growth in the use of hip arthroscopy, standardized data on postoperative pain scores and activity level are lacking. Purpose: To quantify narcotic consumption and use of the stationary bicycle in the early postoperative period after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: In this prospective case series, patients undergoing a primary hip arthroscopy procedure by a single surgeon were asked to fill out a daily survey for 9 days postoperatively. Patients were asked to report their pain level each day on a visual analog scale from 1 to 10, along with the amount of narcotic pain pills they used during those postoperative days (PODs). Narcotic usage was converted to a morphine-equivalent dosage (MED) for each patient. Patients were also instructed to cycle daily starting on the night of surgery for a minimum of 3 minutes twice per day and were asked to rate their pain as a percentage of their preoperative pain level and the number of minutes spent cycling on a stationary bicycle per day. Results: A total of 212 patients were enrolled in this study. Pain levels (POD1, 5.5; POD4, 3.8; POD9, 2.9; P < .0001) and the percentage of preoperative pain (POD1, 51.6%; POD4, 31.8%; POD9, 29.5%; P < .01) significantly decreased over the study period. The amount of narcotics used per day (reported in MED) also significantly decreased (POD1, 27.3; POD4, 22.3; POD9, 8.5; P < .0001). By POD4, 41% of patients had discontinued all narcotics, and by POD9, 65% of patients were completely off narcotic medication. Patients were able to significantly increase the number of minutes spent cycling each day (POD1, 7.6 minutes; POD4, 13.8 minutes; POD9, 19.0 minutes; P < .0001). Patients who received a preoperative narcotic prescription for the affected hip were significantly more likely to require an additional postoperative narcotic prescription ( P < .001). Conclusion: Patients can expect a rapid decrease in narcotic consumption along with a high degree of activity tolerance in the early postoperative period after hip arthroscopy.

scholarly journals Recurrent Hemorrhoids—Efficacy, Utility and Initial Experience with the Use of Stapled Hemorrhoidopexy in Recurrent Hemorrhoids

2021 ◽  
Author(s):  
Ajaz Ahmed Wani ◽  
Suhail Khuroo ◽  
Vikas Kumar Heer ◽  
Saurabh Kumar Jain ◽  
Deepak Rajput ◽  
...  
Keyword(s):  
Case Series ◽  
Standard Technique ◽  
Treatment Modalities ◽  
Stapled Hemorrhoidectomy ◽  
Recurrence Rates ◽  
Pain Scores ◽  
History Of ◽  
Prospective Case Series ◽  
First Time

Abstract Overview Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods The present prospective case series enrolled a total of 87 patients (54 male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. A modification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results Stapled hemorrhoidectomy (SD) was performed in 13 patients who had history of previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD.

Treatment of symptomatic non-unions of the base of the ulnar styloid with plate osteosynthesis

2016 ◽  
Vol 42 (4) ◽  
pp. 382-388 ◽  
Author(s):  
F. A. Nunez ◽  
T. D. Luo ◽  
F. A. Nunez
Keyword(s):  
Plate Osteosynthesis ◽  
Case Series ◽  
Ulnar Styloid ◽  
Distal Ulna ◽  
Level Of Evidence ◽  
Non Union ◽  
Pain Scores ◽  
Low Profile ◽  
Prospective Case Series

The purpose of this prospective case series was to assess the efficacy of plate osteosynthesis using a low profile distal ulna plate for the management of persistently symptomatic non-unions of the base of the ulnar styloid. Six consecutive patients underwent resection of the non-union and plate osteosynthesis with a 2.0 mm distal ulna hook plate. Post-operative measurements of mean pain scores, QuickDASH scores, grip strength, and range of motion parameters showed significant improvements compared with the pre-operative values. No complications were reported at a mean follow-up of 25 months. The present study presents an alternative method for treating symptomatic ulnar styloid non-unions that provides stable fixation with low risk of implant removal. Level of Evidence: Therapeutic IV

The Effect of Burns & Wounds (B&W)/Burdock Leaf Therapy on Burn-Injured Amish Patients

2014 ◽  
Vol 32 (4) ◽  
pp. 327-340 ◽  
Author(s):  
◽  
Nicole M. Kolacz ◽  
Mark T. Jaroch ◽  
Monica L. Bear ◽  
Rosanna F. Hess
Keyword(s):  
Herbal Remedy ◽  
Aloe Vera ◽  
Case Series ◽  
Community Based Participatory Research ◽  
Wheat Germ Oil ◽  
White Oak ◽  
Burn Care ◽  
Pain Scores ◽  
Aloe Vera Gel ◽  
Prospective Case Series

Purpose: The purposes of this pilot study were to measure pain associated with dressing changes, assess the presence of infection, and document healing times of burn-injured Amish in central Ohio using an herbal therapy consisting of Burns and Wounds™ ointment (B&W) and burdock ( Arctium ssp.) leaves. B&W contains honey, lanolin, olive oil, wheat germ oil, marshmallow root, Aloe vera gel, wormwood, comfrey root, white oak bark, lobelia inflata, vegetable glycerin, bees wax, and myrrh. Design: A prospective, case series design guided the study within a community-based participatory research framework. Methods: Amish burn dressers provided burn care. Registered nurses monitored each case and documented findings. Pain scores were noted and burns were inspected for infection during dressing changes; healing times were measured from day of burn to complete closure of the skin. All cases were photographed. Results: Between October 2011 and May 2013, five Amish were enrolled. All had first- and second-degree burns. B&W/burdock leaf dressing changes caused minimal or no pain; none of the burns became infected, and healing times averaged less than 14 days. Conclusion and Implications: The use of this herbal remedy appears to be an acceptable alternative to conventional burn care for these types of burns. The trauma of dressing changes was virtually nonexistent. Nurses working in communities with Amish residents should be aware of this herbal-based method of burn care and monitor its use when feasible.

scholarly journals Three-dimensional analysis of effects of rapid maxillary expansion on facial sutures and bones: A systematic review

2013 ◽  
Vol 83 (6) ◽  
pp. 1074-1082 ◽  
Author(s):  
Farhan Bazargani ◽  
Ingalill Feldmann ◽  
Lars Bondemark
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Case Series ◽  
Rapid Maxillary Expansion ◽  
Three Dimensions ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Maxillary Expansion ◽  
Prospective Case Series

ABSTRACTObjective:To evaluate the evidence on three-dimensional immediate effects of rapid maxillary expansion (RME) treatment on growing patients as assessed by computed tomography/cone beam computed tomography (CT/CBCT) imaging.Materials and Methods:The published literature was searched through the PubMed, Embase, and Cochrane Library electronic databases from January 1966 to December 2012. The inclusion criteria consisted of randomized controlled trials, prospective controlled studies, and prospective case-series. Two reviewers extracted the data independently and assessed the quality of the studies.Results:The search strategy resulted in 73 abstracts or full-text articles, of which 10 met the inclusion criteria. When treating posterior crossbites with a RME device, the existing evidence points out that the midpalatal suture opening is around 20%–50% of the total screw expansion. There seems to be no consistent evidence on whether the midpalatal sutural opening is parallel or triangular. The effect on the nasal cavity dimensions after RME seems to be apparent and indicates an enlargement between 17% and 33% of the total screw expansion. Circummaxillary sutures, particularly the zygomaticomaxillary and frontomaxillary sutures and also spheno-occipital synchondrosis, appear to be affected by the maxillary expansion. Overall, however, the changes were small and the evidence not conclusive.Conclusions:CT imaging proved to be a useful tool for assessment of treatment effects in all three dimensions. The majority of the articles were judged to be of low quality, and therefore, no evidence-based conclusions could to be drawn from these studies.

Treating complex palmar–plantar wounds using a bilaminar ‘trapdoor’ technique: a case series

2021 ◽  
Vol 30 (10) ◽  
pp. 868-873
Author(s):  
Rafaela Ribeiro Marques ◽  
Pedro Soler Coltro ◽  
Juliano Baron Almeida ◽  
Júlio César Dias Castro ◽  
Jayme Adriano Farina Junior
Keyword(s):  
Conflicts Of Interest ◽  
Donor Site ◽  
Case Series ◽  
Glabrous Skin ◽  
Dermal Graft ◽  
Donor Area ◽  
Plantar Region ◽  
Functional Features ◽  
Prospective Case Series ◽  
Easy Integration

Objective: Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar–plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. Method: This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar ‘trapdoor’ technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. Results: At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar–plantar region. Conclusion: This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar–plantar recipient region. Declaration of interest: The authors have no conflicts of interest to declare.

scholarly journals Comprehensive Systematic Review to Identify putative COVID-19 Treatments: Roles for Immunomodulator and Antiviral Treatments

2020 ◽  
Author(s):  
Thomas Hill ◽  
Mark Baker ◽  
Lawrence Isherwood ◽  
Lennard YW Lee
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Standard Of Care ◽  
Positive Trial ◽  
Inclusion Criteria ◽  
Current Standard ◽  
Retrospective Case ◽  
Novel Treatments ◽  
Randomised Control Trials ◽  
Randomised Controlled

Objectives: To identify putative COVID-19 treatments and identify the roles of immunomodulators and antivirals in disease management. Design: Systematic review. Data sources: PubMed, bioRxiv.org and medRxiv.org were searched for studies suggestive of effective treatments for COVID-19. Additional studies were identified via a snowballing method applied to the references of retrieved papers as well as a subsequent targeted search for drug names. Review methods: Inclusion criteria included any case series or randomised control trials in any language that were published from 18th December 2019 to 18th April 2020 and described COVID-19 treatment. Of an initial 2140 studies identified from the initial search, 29 studies were found to meet the inclusion criteria and included in this comprehensive systematic review. Results: 19 studies of antiviral treatments for COVID-19 have been reported and seven studies for immunomodulatory treatments. Six randomised controlled trials have been published with one positive trial for Hydroxychloroquine. This small study consisted of 31 patients though subsequent studies showed contradictory findings. All the remaining studies were observational studies, retrospective case reviews or non-randomised trials and these results are difficult to interpret due to methodological issues. Conclusions: To date, an impressive number of studies have been performed in a short space of time, indicative of a resilient clinical trials infrastructure. However, there is a lack of high quality evidence to support any novel treatments for COVID-19 to be incorporated into the current standard of care. The majority of the studies of treatments for COVID-19 could only be found in pre-print servers. Future clinical reviews should therefore be Comprehensive Systematic Reviews involving pre-print studies to prevent potential unnecessary replications of clinical studies.

PS01.044: PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) IN THE TREATMENT OF REFRACTORY GASTROPARESIS: MID—TERM SINGLE CENTRE EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 62-62
Author(s):  
Rastislav Husťak ◽  
Zuzana Vackova ◽  
Zuzana Rabekova ◽  
Julius Spicak ◽  
Jan Martinek
Keyword(s):  
Conflicts Of Interest ◽  
Treatment Success ◽  
Case Series ◽  
Clinical Effectiveness ◽  
Excellent Outcome ◽  
Single Center Experience ◽  
Idiopathic Gastroparesis ◽  
Upper Gi Endoscopy ◽  
Prospective Case Series ◽  
Per Oral

Abstract Background Gastroparesis is a chronic, debilitating motility disorder. Effective treatment is challenging especially in patients with severe symptoms. G-POEM is an emerging modality for refractory gastroparesis with promising preliminary results. The aim of this prospective case series was to assess the first single-center experience with G-POEM. Main outcomes were: the clinical efficacy defined by an improvement of GCSI ≥ 40% from baseline; gastric emptying study (GES) and safety. Methods Since Nov 2015, a total of 8 patients have undergone G-POEM. The etiology of gastroparesis was post-operative in 5, diabetic in 2 and idiopathic in 1 patient. One patient underwent G-POEM for gastroparesis following a multivisceral transplantation; one underwent G-POEM and POEM as a single procedure for coexisting refractory idiopathic gastroparesis and achalasia. All patients had abnormal GES. F-u visit at 3, 6, 12 and 24M were completed in 7/8 (87.5%), 7/8 (87.5%), 5/8 (62.5%) and 1/8 (12.5%) of patients, respectively. Upper GI endoscopy and GES were performed 3M after G-POEM. Results G-POEM was successfully performed in all patients. Mean procedure time was 75 minutes (range 43–106). After G-POEM, in 7 patients mean GCSI decreased from 3.26 ± 0.96 to 0.79 ± 0.76 (at 3M; P = 0.018), 0,72 ± 0.69 (6M; P = 0.018) and 1.24 ± 0.85 (12M; P = 0.028). One women finished the 24M follow maintaining excellent outcome (mean GCSI 0.77). Treatment success was reached in 6/7 (85%) of patient at 3 and 6 months. GES normalized in all patients, mean T1/2 of GES decreased from 108 ± 30 to 62 ± 23min (P = 0.018); mean residual % at 4h decreased from 17 ± 9.2% to 2.0 ± 2.0% (P = 0.018). One patient developed bleeding ulcer 10 days after G-POEM, which was successfully managed endoscopically (clips) and by a parenteral proton pump inhibitor. Conclusion We report our first experiences with G-POEM for refractory gastroparesis, demonstrating its feasibility and safety with promising mid-term efficacy. A clinical effectiveness of G-POEM needs to be assessed in a large clinical trial. Disclosure All authors have declared no conflicts of interest.

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