Do We Require to Use Antibacterial Prophylaxis in Hand Trauma? Results of a Randomised Prospective Case-Control Trial

The proper management of traumatic hand injury is crucial for wound infection prevention. Antibiotics in various forms and conditions are prescribed to avoid this complication, but the effectiveness is unclear. Most forms used are intravenous solutions, topical ointments, and oral tablets. This prospective case-control trial was conducted in a tertiary care hospital. Healthy adult patients with simple, non-bite, surgically treated hand wounds were included. During the surgery, a proper debridement and irrigation with simple saline was consistently performed. Patients were randomly assigned to one of the eight groups. Seven groups received different antibacterial prophylaxis and one received none. At the two-week postoperative follow-up the wound site was assessed and any local infection was documented. Patients were excluded from the trial if they did not comply to treatment recommendations (i.e. commence antibiotics, applied solutions or ointments on the wound). Overall, 240 patients (80.2% male, mean age 38.7 years), 30 in each study group were included. 226 patients returned for the follow-up, and seven patients were excluded from the trial. Wound infection was observed in five patients from different groups. Thus, the rate of wound infection was 2.28%. A Chi-square test revealed no difference in infection incidence between the groups (p > 0.05). In this study, antibiotics did not affect incidence of wound infection after hand trauma. Attention should be paid to proper debridement and irrigation of the wound as these interventions reduce the risk for wound infection and avoid unnecessary usage of antibiotics.

Expression and Localisation of CD44 Antigen as a Prognostic Factor of Oral Leukoplakia

It is essential to identify markers that could indicate the presence of early molecular changes in premalignant tissues like oral leukoplakia (OL). CD44 adhesion molecule is not only a stem cell marker, but also determines cell proliferation and migration in malignant processes. The aim of our study was to assess the amount and pattern of CD44 antigen expression by epithelial and mononuclear cells in the lamina propria under OL and their role in premalignant lesions. The current study included 102 cases of OL and ten biopsies from healthy oral mucosa. Immunohistochemical CD44 antigen expression was determined in 34 cases by a standard EnVision imaging system in three points of OL: both edges and centre. Statistical analysis was done using GraphPad Prism software version 8.4.0. In OL, statistically significant overexpression of membranous CD44 was demonstrated compared to healthy mucosa (p < 0.0001). The intra-cytoplasmatic CD44 expression of epithelium together with characteristic nuclear changes may be used as a predictive factor for potential malignant transformation of non-homogenous leukoplakia. CD44 expression in mononuclear cells under the basal membrane in OL (p < 0.05) possibly influences the process of premalignant lesion transformation into intraepithelial cancer. Further study of CD44 antigen expression in intra-cytoplasmatic structures is required for better explanation of the role of this glycoprotein.

Inherited Thrombophilias in Thrombosis Advancement in Microvascular Flap Surgery

Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee free flap thrombosis advancement after microvascular flap surgery, patient assessment, flawless surgical technique, and eligible perioperative care are pivotal. In this prospective observational study, we aimed to elucidate the most common inherited single nucleotide polymorphisms (SNPs) attributable to free flap thrombosis. A total of 152 patients undergoing microvascular flap surgery during the study period of 2016–2019 were analysed for five SNPs: rs6025 in Factor V Leiden (FVL) gene, rs1799963 in Factor II (FII) gene, rs2066865 in Fibrinogen Gamma Chain gene (FGG), rs2227589 in SERPINC 1 gene and rs1801133 in Methylene Tetrahydrofolate Reductase (MTHFR) gene. Activated protein C resistance (aPCR), prothrombin, antithrombin (AT), fibrinogen and homocysteine plasma levels were measured to determine association with the analysed SNPs and with free flap thrombosis advancement. Our preliminary results show that carriers of FVL mutation were associated with aPCR, as we observed significantly lower aPCR plasma levels in carriers of genotype C/T, as compared to C/C; p = 0.006 (CI 95%, 0.44 to 1.19). Additionally, mean fibrinogen plasma levels were higher in carriers of FGC gene rs2066865 genotype A/A (5.6 ± 1.81 g/l), as compared to G/A and G/G; p = 0.04 (CI 95%, 0.007 to 1.09); p = 0.004 (CI 95%, 0.48 to 2.49), respectively. The study group included 12 patients (7.9%) with free flap thrombosis. For one patient free flap thrombosis advancement might have been related to the rs6025T – FVL mutation with a PCR plasma level 1.21. Lower aPCR levels was associated with carriers of FVL rs6025 C/T and higher fibrinogen plasma levels with carriers of FGG rs2066865 A/A, suggesting that these genotypes might predict higher free flap thrombosis risk, but we found no significant association between analysed SNPs and free flap thrombosis advancement.

Does the Course of Disease Influence the Development of Fatigue in Rheumatoid Arthritis Patients?

Patients with rheumatoid arthritis (RA) typically have many permanently inflamed joints. The inflammation inside the body can lead to general physical weakness, exhaustion, and drowsiness. This feeling of extreme tiredness is also called “fatigue”. Some people find this to be the worst symptom of the disease. However, the clinical significance of fatigue and its pathogenesis have not been recognised. This study aimed to determine the development of fatigue depending on activity and aggressiveness of RA. To achieve the goal, patients were interviewed and indicators of disease activity and aggressiveness were determined: rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), immunoglobulins IgA RF, IgM RF, IgG RF and anti-carbamylated protein antibodies (anti-CarP). Based on the results of the survey, RA patients were divided into two groups — with and without fatigue. In the group of RA patients with fatigue, statistically more often an increase in IgA RF, IgM RF, and IgG RF levels was observed in those with elevated RF level, higher IgM RF and IgG RF levels were associated with increase in IgA RF level, and increase in the IgG RF and anti-CarP levels with elevation in the IgM RF level. A higher IgG RF level contributed to a higher anti-CarP level increase. Significant differences in the levels of clinical and laboratory inflammatory markers were not observed between the RA patients with and without fatigue. The obtained data suggest that the aggressive course of RA, more than inflammation, may contribute to the development of fatigue in RA patients.

Vacuum-Assisted Abdominal Closure in Surgical Emergency: A Single Institution Experience Treating a Cohort with a Prevalence of Faecal Peritonitis

Vacuum-assisted abdominal closure (VAAC) has evolved as a promising method for treatment of emergent surgical patients. The aim of the study was an assessment of the complication rate and outcomes following routine application of VAAC in a cohort of patients suffering predominantly with peritonitis of the lower gastrointestinal tract (GIT) origin. The prospectively collected data was analysed retrospectively, including demographic data, aetiological factors, comorbid conditions and severity of the disease. The indications for VAAC included complicated intra-abdominal infection, purulent peritonitis with sepsis and/or risk of increased intra-abdominal pressure. In total, 130 patients were managed with VAAC. The median age was 63.5 years, with a predominance of male patients (61.5%). Systemic inflammatory response was present in 68.5%, the median C-reactive protein (CRP) was 239.58 mg/l, Procalcitonin (PCT) level 7.02 ng/ml, and lactate 1.84 mmol/l before intervention. The median Sequential Organ Failure Assessment (SOFA) score was 4 and the Mannheim Peritonitis Index was 26. Sepsis developed in 87.0% of patients, and 43.8% had septic shock. VAAC was applied in 58.5% due to a perforation of the lower GIT, in 26.1% due to perforation of the upper GIT, and in 15.4% for other reasons. A median of two (interquartile range, IQR 1–3) VAAC system changes were performed in a period of 7 (IQR 4–11) days. In 88.6% of cases, multiple types of microorganisms were present. The application of VAAC resulted in a significant decrease of the postoperative SOFA score, and CRP, PCT and lactate levels (p < 0.001). The complications included a “frozen abdomen”, enterocutaneous fistula, intraabdominal abscess and bleeding in 7.7%, 5.4% and 6.0% cases, respectively. Primary abdominal closure was accomplished in 76.2%, resulting in a 23.1% mortality rate. VAAC was found to be safe in the treatment of abdominal sepsis including in patients with faecal peritonitis. Complete abdominal closure can be achieved in the majority of patients resulting in a lower mortality rate.

Aqueous C60 Fullerene Solution Effects on Cell Viability

Fullerenes are carbon nanoparticles with the ability to quench reactive oxygen species. The biomedical potential of fullerenes is diminished by their low solubility in water, but many approaches have been developed to bypass this problem, like chemical modification of the carbon cage and the use of the solvent exchange method to transfer fullerenes from one solvent to the other. These two approaches were used in this study. Carboxylated fullerene aqueous solution was acquired using solvent exchange method transferring fullerene nanoparticles (C60) from toluene to water. Effects of varying concentration (0.5, 1, 1.5, 2, 2.5, 3, 5, 10 µM) of aqueous fullerene solution on cell viability and their antioxidative capabilities were evaluated on PC-3 and on monocytes isolated from a blood donor using Resazurin Cell Viability Assay. PC-3 cell viability was drastically affected by the 10 µM fullerene solution but remained relatively stable when treated with other concentrations even after longer periods of incubation with resazurin dye. Elevated cell viability was observed in monocytes treated with various fullerene concentrations, possibly indicative of fullerene protective activity against oxidative stress.

Significance of Hypouricaemia in the Development of Neurodegenerative Diseases

Hypouricaemia has received relatively little attention in the literature. As a result, there is less awareness or understanding of the potential risks of low uric acid levels. Emerging research indicates that normal uric acid levels may have an antioxidative and neuroprotective effect. This study aims to investigate possible associations between hypouricaemia and neurodegenerative disease. Data was collected from seventy-seven outpatients and inpatients who underwent routine uric acid testing, who were then stratified into patients with and without neurodegenerative disease. Patients with renal pathologies and patients using uric acid altering medications were excluded from the study. There was a significant difference in the prevalence of Alzheimer’s disease between hypouricemic and normouricemic patients (p = 0.001), however there was no difference in the prevalence of vascular dementia (p = 0.45). This study provides evidence that hypouricaemia has potential effects on health, specifically on the rate of neurodegenerative diseases such as Alzheimer’s disease and gives weight to the potential neuroprotective role of uric acid.

Acute Complicated Necrotising Pancreatitis Treated with Video-Assisted Retroperitoneal Debridement

Acute necrotising pancreatitis is a complex disease with high morbidity and mortality rates. In cases of infected necrosis, treatment consists of a step-up approach involving endoscopic or mini-invasive surgical methods. In some cases, there are extremely rare complications. In addition, the underlying comorbidities worsen the course of the disease. We report a case of a 32-year-old male with acute necrotising pancreatitis complicated with recurrent retroperitoneal abscesses, sepsis, iatrogenic pylephlebitis, exacerbation of underlying Crohn’s disease, and the outcome of the treatment was successful. During the period of hospitalisation, one ultrasound-guided percutaneous drainage, two computed tomography-guided punctures of the retroperito-neal space (percutaneous and transhepatic) and five video-assisted retroperitoneal debridement procedures were carried out. The patient was discharged after 185 days of hospitalisation.

Early Correction of Post-Kidney Transplant Hyperglycaemia is Associated with Reduction of the Prevalence of Post-Transplant Diabetes Mellitus

Our study was focused on identification and correction of early hyperglycaemia, with the aim to reduce the risk of developing post-transplant diabetes mellitus (PTDM) and its associated complications. In a single centre, the prospective study included adult kidney transplant recipients without diabetes mellitus whose pre-transplant glucometabolic data did not show signs of diabetes mellitus. Starting from the first day after kidney transplantation, patients were closely monitored for hyperglycaemia; glucose level measurements were started to obtain pre-prandial levels. If the blood glucose level exceeded 11.1 mmol/l, hyperglycaemia was corrected with short-acting insulin. A total of 14 patients completed a three-month follow-up. During the first post-transplant week, the blood glucose level exceeded 11.1 mmol/l in nine patients (63.9%). From those patients five (55.5%) did not develop PTDM. None of the patients who did not need insulin treatment developed PTDM. Higher pre-lunch glucose levels increased the risk of developing PTDM (p = 0.006). Patients with diabetes required a two times higher insulin dosage than other patients during the first post-transplantation week. We found that hyperglycaemia is a common problem in the early post-transplant period. Early recognition and correction of inpatient hyperglycaemia was associated with reduction of the prevalence of PTDM in more than a half of the patients in the studied group at three months post transplant.

What We Need to Learn When Exploring the Mixed Basal Cell Carcinoma of Head and Neck

Coexistence of different histopathological types of basal cell carcinomas (BCC) in the same anatomical localisation is rare, and, therefore, is engaging for histopathologists and clinicians. In many cases, the determination of a neoplasm type remains difficult, since BCC may consist of more than one histopathological subtype. Mixed BCCs often present with an aggressive course and recurrence when compared to other subtypes of a tumour. Furthermore, tumours of this type are associated with time-consuming treatment and not a very satisfactory cosmetic result, thus worsening the quality of the patient’s life. Several clinical studies have been published regarding the histopathologically diverse tumours developed in the same anatomical region; however, largely peculiarities of mixed BCCs are not explored sufficiently. The purpose of this study was to substantiate the use of dermoscopy and morphology, assessing mixed type BCC of the head and neck. The tumours were removed with a surgical excision of 1 cm margins, and the tumour sites were assessed in a 24-month-long follow-up period. The dermoscopic characteristics of mixed and aggressive BCC are analysed in this study. Finally, to better estimate the invading cone of the tumour, a complex morphology, which included collagen type IV and podoplanin immunohistochemistry, and electron microscopy were used.