A Histological Evaluation of Artificial Dermal Scaffold Used in Micrograft Treatment: A Case Study of Micrograft and NPWT Performed on a Postoperative Ulcer Formation after Tumor Resection

Background and Objectives: Wound healing (WH) is a complex natural process: the achieving of a proper WH with standard therapies sometimes is not fulfilled and it is often observed in aged and diabetic patients, leading to intractable ulcers. In recent years, autologous micrograft (AMG) therapies have become a new, effective, and affordable wound care strategy among both researchers and clinicians. In this study, a 72-year-old female patient underwent a combination of treatments using micrograft and negative pressure wound therapy (NPWT) on a postoperative skin ulcer after a benign tumor resection on the back with the aim to present an innovative method to treat skin ulceration using AMG combined with an artificial dermal scaffold and NPWT. Materials and Methods: A section of the artificial dermal scaffold, infused with micrografts, was sampled prior to transplant, and sections were collected postoperatively on days 3 and 7. Hematoxylin-eosin (HE) and immunohistochemical stains were employed for the evaluation of Cytokeratin AE1/AE3, desmin, and Factor VIII. Additionally, on postoperative day 3, NPWT dressing was evaluated using HE stains, as well. The resulting HE and immunostaining analysis revealed red blood cells and tissue fragments within the collagen layers of the artificial dermis prior to transplant. On postoperative day 3, collagen layers of the artificial dermis revealed red blood cells and neutrophils based on HE stains, and scattering of cytokeratin AE1/AE3-positive cells were detected by immunostaining. The HE stains on postoperative day 7 showed more red blood cells and neutrophils within the collagen layers of the artificial dermis than on day 3, an increase in cytokeratin AE1/AE3-positive cells, and tissue stained positively with desmin and Factor VIII. Results: Results suggest that the effects of both micrografts and migratory cells have likely accelerated the wound healing process. Furthermore, the NPWT dressing on day 3 showed almost no cells within the dressing. This indicated that restarting NPWT therapy immediately after micrograft transplant did not draw out cells within the scaffold. Conclusions: Micrograft treatment and NPWT may serve to be a useful combination therapy for complex processes of wound healing.

Hemofilia neonatal reporte de caso

Introducción: La Hemofilia se origina por déficit o ausencia del factor VIII o IX, siendo la hemofilia A cinco veces más frecuente que la B. Aproximadamente el 30 % de todos los casos de hemofilia se produce en ausencia de una historia familiar positiva, y por lo tanto puede pasar desapercibida al nacer. Objetivo: Describir un caso de hemofilia A neonatal, enfatizar la importancia de considerar esta enfermedad dentro del diagnóstico diferencial en los síndromes hemorrágicos del recién nacido. Materiales y Método: Reporte de caso, neonato masculino de 3 días de vida, producto de cuarta gesta, obtenido por cesárea, es referido por presentar trastorno de la coagulación acompañado de edema en piel cabelluda, recibió Glóbulos rojos concentrados y factor VIII por antecedente patológico familiar de hermano Hemofílico A, con manejo clínico multidisciplinario y evolución favorable. Resultados: Dosificación de Factor VIII con déficit de 0.4% confirmó el diagnóstico de Hemofilia A Neonatal, durante su seguimiento clínico de 2 meses, presentó evolución favorable, sin evidencia de sangrado. Conclusiones: La Hemofilia en el periodo neonatal es un reto clínico debido a que no es frecuente, debemos estar atentos de los signos de sangrado anormal para un abordaje, diagnóstico y tratamiento adecuado.

Subacute Spinal Subdural Hematoma in One-Year Old Boy Due to Severe Hemophilia A

Background: Paraparesis may result from a variety of or primary central nervous system conditions or systemic disorders, and although rare, it may also caused by spinal cord hemorrhage. Spontaneous spinal subdural hematomas (SSDH) are most frequently associated with coagulopathies. People with congenital clotting disorders such as hemophilia are at increased risk for experiencing spontaneous spinal subdural hemorrhage at unusual sites, which is a rare case and a neurological emergency required urgent recognition. We report a boy with paraparesis caused by subacute SSDH due to hemophilia A. Case Presentation: A 15 month-old boy, with chief complain of difficulty in moving his leg and pain when walking, physical examination revealed a lower motor neuron lesion, laboratory showed a low factor VIII at 0.4% level, Magnetic Resonance Imaging (MRI) showed anterior and posterior displacement of the spinal cord due to the presence of the subacute subdural hematoma extending from 1st cervical to 1st lumbar spine. He assessed with inferior paraparesis caused by subacute spinal subdural hematoma due to hemophilia A. The patient’s condition was improved after received replacement therapy of factor VIII and proper laminectomy neurosurgery. Conclusion: This case showed an approach for a comprehensive diagnostic and management for a rare case of paraparesis due to hemophilia. Pay attention to the physical examination which shows a lower motor neuron lesion in an acute paralysis cases, there is still a possibility that it is an upper motor neuron lesion.

Real-World Rates of Bleeding, Factor VIII Use, and Quality of Life in Individuals with Severe Haemophilia A Receiving Prophylaxis in a Prospective, Noninterventional Study

Regular prophylaxis with exogenous factor VIII (FVIII) is recommended for individuals with severe haemophilia A (HA), but standardised data are scarce. Here, we report real-world data from a global cohort. Participants were men ≥18 years old with severe HA (FVIII ≤ 1 IU/dL) receiving regular prophylaxis with FVIII. Participants provided 6 months of retrospective data and were prospectively followed for up to 12 months. Annualised bleeding rate (ABR) and FVIII utilisation and infusion rates were calculated. Differences between geographic regions were explored. Of 294 enrolled participants, 225 (76.5%) completed ≥6 months of prospective follow-up. Pre-baseline and on-study, the median (range) ABR values for treated bleeds were 2.00 (0–86.0) and 1.85 (0–37.8), respectively; the median (range) annualised FVIII utilisation rates were 3629.0 (1008.5–13541.7) and 3708.0 (1311.0–14633.4) IU/kg/year, respectively; and the median (range) annualised FVIII infusion rates were 120.0 (52.0–364.0) and 122.4 (38.0–363.8) infusions/year, respectively. The median (range) Haemo-QoL-A Total Score was 76.3 (9.4–100.0) (n = 289), ranging from 85.1 in Australia to 67.7 in South America. Physical Functioning was the most impacted Haemo-QoL-A domain in 4/6 geographic regions. Despite differences among sites, participants reported bleeding requiring treatment and impaired physical functioning. These real-world data illustrate shortcomings associated with FVIII prophylaxis for this global cohort of individuals with severe HA.