Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Treatment of a Chronic Vulvar Wound by Hyperbaric Oxygen Therapy (HBOT)

We hereby report the case of a 66-year-old obese patient (BMI 30) with type 2 diabetes, who presented a chronic vulvar lesion on the left labia majora following surgical drainage of an abscess. After multiple unsuccessful treatments by antibiotics and local wound care, we proposed a trial of hyperbaric oxygen therapy (HBOT). The patient fully recovered after 54 sessions at 2.5 ATA, 95 minutes each. HBOT has been studied for perineal lesion such as skin atrophy or necrosis caused by irradiation but not for vulvar nonhealing chronic lesions in the case of impaired vascularization caused by diabetes. This case is, to our knowledge, one of the first publications about the healing boost of HBOT in chronic vulvar wounds due to vascular impairment.

Modelling Outpatients Cost of Wound Dressing in Nigeria: A Prospective Study

Background: Estimating the direct cost of wound dressing poses a challenge to patients, nurse managers, hospital administrators, health maintenance organisations and other policy makers. This study therefore model the weekly cost of wound dressing in South West NigeriaMethods: A descriptive cross sectional research design was utilized to assess the cost of wound dressing among outpatients’ clinics attendees. An inventory of direct cost of wound dressing per week consisting of cost of materials, lotion and consumables were recorded. The data collection was for period of three months in three selected Teaching Hospitals South West Nigeria. Then modelling weekly cost of wound types was done by regression analysis. The effect of various independent variables such as age, occupation, family size, monthly income, aetiology, diagnosis, wound type, comorbidities, frequency of wound dressing and health insurance coverage on cost of wound dressing per week was considered. Ethical approval was obtained from each of the hospital and Covid-19 precautions were observed.1 USD equalled ₦570Results: The estimated cost of wound dressing per week with no contribution from other variables was found to be ₦36,922- Open wound, ₦6011-Leg ulcer, ₦3768- Cancer wound, ₦2785- Diabetic Foot Ulcer, ₦610-Surgical wound. Only frequency of wound dressing was found to contribute to weekly cost of leg ulcers (P value= 0.003)Conclusions: The estimated cost of various type of wound provides yardstick for determining the weekly cost of wound dressing in Nigeria. Also, frequency of wound dressing is a major determinant of the outpatient cost of dressing. Therefore, it is imperative for nurses to render high quality wound care to match up with the huge financial commitment from patients and families

The chronic wound virome: phage diversity and associations with wounds and healing outcomes

Two leading impediments to chronic wound healing are polymicrobial infection and biofilm formation. Recent studies have characterized the bacterial fraction of these microbiomes and have begun to elucidate compositional correlations to healing outcomes. However, the factors that drive compositional shifts are still being uncovered. The virome may play an important role in shaping bacterial community structure and function. Previous work on the skin virome determined that it was dominated by bacteriophages, viruses that infect bacteria. To characterize the virome, we enrolled 20 chronic wound patients presenting at an outpatient wound care clinic in a microbiome survey, collecting swab samples from healthy skin and chronic wounds before and after a single, sharp debridement procedure. We investigated the virome using a virus-like particle enrichment procedure, shotgun metagenomic sequencing, and a k-mer-based, reference-dependent taxonomic classification method. Taxonomic composition, diversity, and associations to covariates are presented. We find that the wound virome is highly diverse, with many phages targeting known pathogens, and may influence bacterial community composition and functionality in ways that impact healing outcomes.

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

Introduction: Virtual reality (VR) has the potential to lessen pain and anxiety experienced by pediatric patients undergoing burn wound care procedures. Population-specific variables require novel technological application and thus, a systematic review among studies on its impact is warranted.Objective: The objective of this review was to evaluate the effectiveness of VR on pain in children with burn injuries undergoing wound care procedures.Methods: A systematic literature review was performed using PubMed and CINAHL databases from January 2010 to July 2021 with the keywords “pediatric,” “burn,” “virtual reality,” and “pain.” We included experimental studies of between- and within-subjects designs in which pediatric patients’ exposure to virtual reality technology during burn wound care functioned as the intervention of interest. Two researchers independently performed the literature search, made judgements of inclusion/exclusion based on agreed-upon criteria, abstracted data, and assessed quality of evidence using a standardized appraisal tool. A meta-analysis was conducted to evaluate the effectiveness of the VR on burning procedural pain in pediatric population. Standardized mean difference (SMD) was used as an index of combined effect size, and a random effect model was used for meta-analysis.Results: Ten articles published between January 2010 and July 2021 passed the selection criteria: six randomized controlled trials and four randomized repeated-measures studies. Consistent results among the studies provided support for VR as effective in reducing pain and potentially pain related anxiety in children undergoing burn wound care through preprocedural preparation (n = 2) and procedural intervention (n = 8). A random effects meta-analysis model indicated a moderate and significant combined effect size (SMD = 0.60, 95% CI = 0.28–0.93, p = 0.0031) of VR effects on pain intensity ratings with no significant heterogeneity of VR intervention effects between studies. Only one study reported direct influence of VR intervention on pre-procedural situational anxiety with a moderate effect size (Cohen’s d = 0.575, 95%CI = 0.11–1.04).Conclusion: Children’s exposure to VR during burn care procedures was associated with lower levels of pain and pain related anxiety. Moderate to large effect sizes support the integration of VR into traditional pediatric burn pain protocols irrespective of innovative delivery methods and content required for use in burned pediatric patients.

Giant bladder stone resulting in acute kidney injury; a case report and review of literature

A giant bladder stone is very rare in adults. We report a case of giant bladder stone causing acute kidney injury in a 23-year-old male, who presented with lower urinary tract symptoms (LUTS) characterized by both irritative and obstructive LUTS. In addition, he also had episodes of reddish urine for the past decade. A non-contrast-enhanced CT scan was used for the diagnosis. Open cystolithotomy was performed and a 500g weighing stone was removed. He developed a superficial surgical site infection which was treated with wound care. He was discharged improved. Improvement in symptoms and serum creatinine was noted on follow-up.

Giant bladder stone resulting in acute kidney injury; a case report and review of literature

A giant bladder stone is very rare in adults. We report a case of giant bladder stone causing acute kidney injury in a 23-year-old male, who presented with lower urinary tract symptoms (LUTS) characterized by both irritative and obstructive LUTS. In addition, he also had episodes of reddish urine for the past decade. A non-contrast-enhanced CT scan was used for the diagnosis. Open cystolithotomy was performed and a 500g weighing stone was removed. He developed a superficial surgical site infection which was treated with wound care. He was discharged improved. Improvement in symptoms and serum creatinine was noted on follow-up.

Care Giver Competency in Prevention Risk of Diabetic Foot Ulcer in Diabetes Mellitus Patients

Increasing in the incidence of diabetic foot ulcer (DFU) among diabetes mellitus patients (DM), which then access to health services is so far, as well as the lack of knowledge of the local community in preventing and caring for DFU made researchers try to initiate training related to prevention and basic wound care for village health cadres, community leaders, and families family members with DM and at risk for UKD. The activity, which carried out in March 2021, involved the puskesmas in Sui District. Raya, Kab. Kubu Raya. After obtained a permit to carry out activities, the Team briefly contacted the community with the assistance of the Head of RT and RW. Participants who toke part in this activity were those who lived or have a family with diabetes mellitus. Participants were given training related to prevention and treatment of basic wounds, which in the end evaluation followed by publication.