Collagen dressing versus silver sulfadiazine dressings in partial thickness burns-prospective study

Background: Occurrence, pathophysiology and management of burns is complex. It is a painful condition and topical management of burns is a challenging task. An ideal topical dressing which allows faster healing with reduction of pain, prevent infection, leads to a good scar formation and which is cost effective is required. Thus, there is a need to study the effectiveness of collagen dressing in comparison with conventional silver sulphadiazine dressing (SSD) in terms of pain score, healing time and cost efficiency.Methods: This prospective randomized comparative study includes patients with partial thickness burns, <40% BSA and not older than 48 hours, admitted to department of surgery of RL Jalappa hospital and research centre Tamaka Kolar during the period December 2019 to March 2020. 34 patients were studied, these patients were randomized into collagen dressing or silver sulphadiazine dressing group of 17 each.Results: The 34 patients admitted with partial thickness burns, <40% BSA were divided into two equal and comparable groups. Patients subjected to collagen dressings were classified under group I and those who underwent 1% silver sulphadiazine dressings were classified as group II.Conclusions: The collagen dressing is more cost effective than SSD. SSD has disadvantage of the large number of dressings prolonged hospital stay, amount pain, loss of time and labour of the patient and the accompanying person which make collagen dressing more cost effective as it is most of the time a single dressing.

The Prophylactic Effect of Silver Sulphadiazine and Chloroquine in-situ Gel Formulation Against Rodent Malaria Parasite Plasmodium Berghei

Background: Despite the technological advances made in the pharmaceutical field, globally, malaria remains one of the major causes of mortality. The resistance of malaria parasites to conventional drugs is one of the primary challenges facing researchers. Therefore, the aim of this study is to examine the validity of a single dose in-situ gel formulation of chloroquine and silver sulfadiazine against rodent model malaria, Plasmodium berghei.Results: Following administration of the free or gel drug formulations to mice four days before infection, the in-situ gelled formulation were not found to improve drug parasitaemia nor increase the life span of the infected mice. This may be attributed to the initial high burst of drug release within the initial days of treatment before infection. Conclusions: Additional studies are warranted to determine the timing of the malarial drug burst, and to design the prophylactic interval based on the drug pharmacokinetics and their metabolites.

Silver Sulphadiazine- xanthan gum- hyaluronic Acid Composite Hydrogel for Wound Healing: Formulation Development and in vivo Evaluation

Background: Development and modifications of hybrid hydrogels have been done to improve biological properties or to decrease the disadvantages of biomaterials.Objectives: The efficacy of hyaluronic acid in combination with silver sulphadiazine in wound healing was investigated. The retaining properties of xanthan gum to aid re- epithelialization was also explored.Materials and Method: Four hybrid hydrogels comprising of different concentrations of xanthan gum, eugenol and antimicrobial agents – hyaluronic acid and silver sulphadiazine were formulated. The physicochemical properties of the gels were assessed, and the antimicrobial effectiveness of the different hydrogel were determined using the extent of wound closure as an index.Results: The hydrogel samples had approximately 90% moisture content with rate of evaporation between 26- 32% for a 5 h period at 37oC. The pH of all formulations was between 7.59 - 8.05 considering that the formulation would be applied to underlying tissues of the skin. The swelling index after a 12 h period in distilled water was 10% for HX 1, 27% for HX 2, 29% for HX 3 and 30% for HX 4. There was no new peak observed in the FTIR analysis to indicate formation of new bonds.Conclusion: Incorporation of silver sulphadiazine at 0.1% and hyaluronic acid at 1.5% in the formulation yielded the best results with regards to least presence of inflammatory cell infiltrates and excellent wound closure at 14 days compared to the control and other formulations. Further investigation may be required for clinical use as an effective wound dressing material. Keywords: Silver sulphadiazine, Xanthan gum, Hyaluronic acid, Hydrogels, Wound healing.

Role of Topical Heparin in Treatment of Burn at Tertiary Care Hospital in Western Rajasthan

Background: Heparin is a multifaceted compound with uses not only as an anticoagulant, but also as an anti-inflammatory, anti-allergenic, anti-histaminic, anti-serotonin, anti-proteolytic and neoangiogenic agent. The aim of the study was to study the effect of topical heparin in the management of burns in terms of morbidity, mortality & safety. Subjects and Methods: A hospital based RCT with total duration of 16 months from June, 2018 to September, 2019 with 100 patients (age between 15-45 years, burns from 20-60%, with less than 48 hours duration), randomly enrolled into 2 groups, after initial resuscitative measures, 50 cases receiving Topical Heparin treatment, 50 controls receiving conventional treatment (1% silver sulphadiazine) with i.v. antibiotics, after explaining the study objectives and taking informed written consent. Data analysis was performed using Epi Info software. Results: Patients treated with topical heparin experienced statistically significant (p<0.05) improved pain relief, rapid healing, lesser complications and reduced duration of hospital stays. Conclusion: The current study demonstrates that topical heparin can improve clinical outcomes in the treatment of burn injury.

The Effect of Silver Nanoparticles on the Healing Process of Excisional Skin Wounds in Adult Albino Rats: Histological and Immunohistochemical Study

Background The ultimate goal for wound healing is a speedy recovery with minimal scarring. Different approaches have been used for achieving this goal such as antimicrobials and cell growth promoting agents. Recently, silver nanoparticles (AgNps) have become of interest in biomedical applications, because of their antibacterial, antifungal, antiviral and anti-inflammatory activity. Aim was to investigate the role of AgNps on the healing process of excisional skin wounds in adult male albino rats. Material & Methods 72 male albino rats weighing 200 g were obtained from research center, Ain Shams Faculty of Medicine and subjected to excisional skin wounds 1.5 cm in diameter on their mid-backs. Then rats were divided into 4 groups 18 rats each; control (group I) skin wounds were left to heal naturally. Other wounds were topically treated once daily with methylcellulose hydrogel (group II), silver sulphadiazine (group III), and AgNps in methylcellulose hydrogel (group IV). For each group 6 rats were sacrificed on each of the following days post-wounding; 3rd, 7th and 14th. Skin specimens from all groups were fixed in 10% neutral formalin & processed for paraffin sections which were stained with Hx & E, Mallory’s Trichrome and vascular endothelial growth factor (VEGF). Using image analysis software, number of (macrophages, newly formed blood vessels & fibroblasts) and area % of collagen fibers deposition were assessed and statistically analyzed. Results Control and methylcellulose hydrogel groups revealed almost similar results. Re-epithelialization started on day 3 post-wounding only in AgNps treated group and on day 7 in all other groups. Epithelialization was complete on day 14 only in AgNps treated group and the dermis was mostly regenerated with the appearance of skin appendages. Components of the granulation tissue varied considerably among the studied groups and across the three time points. In Hx & E stained sections the number of macrophages was highest in AgNps treated group on day 3 post-wounding then was the lowest on days 7 and 14 compared with other groups as confirmed by image analysis. Neovascularization started on day 3 in all groups but was prominent on AgNps treated group which showed high density on day 7 as proved statistically and by results of VEGF immune staining. The number of the newly formed blood vessels declined on day 14 in AgNps treated group and remained high in silver sulphadiazine group and showed maximum density in control groups. Statistical analysis proved that the number of fibroblasts in AgNps group was maximum on day 7 & decreased to minimum on day 14 compared with all other groups. In Mallory’s trichrome stained sections the area percent of collagen fibers deposition in the granulation tissue was maximum in AgNps treated group across all periods of the study compared to other studied groups. Conclusion AgNps showed advantage of rapid healing of excisional skin wounds in rats compared with traditional methods of treatment. It might be the treatment of choice particularly for high risk patients.