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Minerva Surgery Apr 2024Infections in the pleural space have been a significant problem since ancient times and continue to be so today, with an incidence of 52% in patients with post-pneumonia... (Review)
Review
Infections in the pleural space have been a significant problem since ancient times and continue to be so today, with an incidence of 52% in patients with post-pneumonia syndrome. Typically, these effusions require a combination of medical treatment and surgical drainage, including debridement and decortication. Researchers have been studying the use of intrapleural fibrinolytics in managing complicated pleural effusions and empyema, but there is still ongoing debate and controversy among clinicians. Empyema has traditionally been considered a surgical disease, with antibiotics and chest tube drainage being the initial treatment modality. However, with advances in minimally invasive procedures such as video-assisted thoracoscopic surgery (VATS) and the use of intrapleural fibrinolytics, medical management is now preferred over surgery for many cases of empyema. Surgical options, such as open thoracotomy, are reserved for patients who fail conservative management and have complicated or chronic empyema. This comprehensive review aims to explore the evolution of various management strategies for pleural space infections from ancient times to the present day and how the shift from treating empyema as a surgical condition to a medical disease continues.
Topics: Humans; Empyema, Pleural; Thoracic Surgery, Video-Assisted; Drainage; Pleural Effusion; Thoracotomy
PubMed: 38264874
DOI: 10.23736/S2724-5691.23.09992-6 -
Journal of Drugs in Dermatology : JDD Oct 2023Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent nodules and abscesses leading to subsequent scarring and tunnel... (Review)
Review
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent nodules and abscesses leading to subsequent scarring and tunnel formation. Despite being a fairly common disease with a significant impact on quality of life, only one drug, adalimumab, is currently US Food and Drug Administration (FDA)-approved for treating HS. However, there are many clinical trials underway to address this gap in care for patients with HS.
METHODS
All clinical trials related to HS as of 10/03/2022 were reviewed via clinicaltrials.gov. Studies on topical or systemic medical therapies were included and available results reported if they were ongoing or completed within 6 months prior to the search.
RESULTS
Over 30 drugs with at least 20 different mechanisms of action are currently in development for the treatment of HS. While many of these are in phase 2 trials, several are undergoing phase 3 trials and will likely become viable treatment options in the next 5 years.
CONCLUSIONS
Following years of limited treatment options for HS, drug development has accelerated significantly, forecasting more treatment possibilities and better disease control for many patients. J Drugs Dermatol. 2023;22(10):1021-1026 doi:10.36849/JDD.7339.
Topics: Humans; Hidradenitis Suppurativa; Quality of Life; Adalimumab; Drug Development
PubMed: 37801538
DOI: 10.36849/JDD.7339 -
Microbial Ecology Dec 2023Plastic waste is a global environmental burden and long-lasting plastic polymers, including ubiquitous and toxic polyurethanes (PUs), rapidly accumulate in the water...
Plastic waste is a global environmental burden and long-lasting plastic polymers, including ubiquitous and toxic polyurethanes (PUs), rapidly accumulate in the water environments. In this study, samples were collected from the three alkaline groundwater occurrences in the geotectonic regions of the Pannonian basin of northern Serbia (Torda and Slankamen Banja) and Inner Dinarides of western Serbia (Mokra Gora) with aim to isolate and identify bacteria with plastic- and lignocellulose-degrading potential, that could be applied to reduce the burden of environmental plastic pollution. The investigated occurrences belong to cold, mildly alkaline (pH: 7.6-7.9) brackish and hyperalkaline (pH: 11.5) fresh groundwaters of the SO - Na + K, Cl - Na + K and OH, Cl - Ca, Na + K genetic type. Full-length 16S rDNA sequencing, using Oxford Nanopore sequencing device, was performed with DNA extracted from colonies obtained by cultivation of all groundwater samples, as well as with DNA extracted directly from one groundwater sample. The most abundant genera belong to Pseudomonas, Acidovorax, Kocuria and Methylotenera. All screened isolates (100%) had the ability to grow on at least 3 of the tested plastic and lignocellulosic substrates, with 53.9% isolates degrading plastic substrate Impranil® DLN-SD (SD), a model compound for PUs degradation. Isolates degrading SD that were identified by partial 16S rDNA sequencing belong to the Stenotrophomonas, Pseudomonas, Paraburkholderia, Aeromonas, Vibrio and Acidovorax genera. Taking into account that plastics, including commonly produced PUs, are widespread in groundwater, identification of PUs-degrading bacteria may have potential applications in bioremediation of groundwater polluted with this polymer.
Topics: Humans; Polyurethanes; Comamonadaceae; DNA, Ribosomal; Groundwater; Pseudomonas; Suppuration
PubMed: 38153543
DOI: 10.1007/s00248-023-02338-z -
American Journal of Clinical Dermatology Nov 2023Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study...
INTRODUCTION
Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval.
METHODS
This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12-17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics Data Mart Database during the period 1 January 2016 to 31 December 2018.
RESULTS
Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively).
CONCLUSION
In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.
Topics: Adult; Humans; United States; Adolescent; Retrospective Studies; Hidradenitis Suppurativa; Diabetes Mellitus; Cost of Illness; Biological Products
PubMed: 37378875
DOI: 10.1007/s40257-023-00796-2 -
Journal of Visceral Surgery Dec 2023Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its... (Review)
Review
Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
Topics: Humans; Hidradenitis Suppurativa; Abscess; Surgeons
PubMed: 37722942
DOI: 10.1016/j.jviscsurg.2023.07.008 -
Chirurgie (Heidelberg, Germany) Dec 2023A splenic abscess is a rare disease found in less than 1% of all autopsy studies. Several different diseases are associated as a predisposing factor, such as septic... (Review)
Review
A splenic abscess is a rare disease found in less than 1% of all autopsy studies. Several different diseases are associated as a predisposing factor, such as septic bacteremia due to endocarditis or diverticulitis, previous splenic trauma, immunosuppressive medication or diseases. The reported mortality in the literature is up to 24.5% in correctly diagnosed and treated cases. The diagnostic work-up primarily comprises sonography and computed tomography as well as a percutaneous puncture for determination of the pathogen. In most cases, a percutaneous interventional drainage treatment is sufficient and a splenectomy is necessary only in refractory cases.
Topics: Humans; Splenic Diseases; Abscess; Abdominal Abscess; Tomography, X-Ray Computed; Drainage; Intraabdominal Infections; Cardiovascular Abnormalities
PubMed: 37917403
DOI: 10.1007/s00104-023-01990-y -
Skin Therapy Letter Mar 2024Hidradenitis suppurativa (HS) is a severe, debilitating, chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses and draining sinus... (Review)
Review
Hidradenitis suppurativa (HS) is a severe, debilitating, chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses and draining sinus tracts in intertriginous areas. While this condition appears to stem from follicular unit dysfunction, its cause is multifactorial and the exact pathogenesis has yet to be fully elucidated. These factors make treatment selection challenging and contribute to variable therapeutic response among affected patients. Typical regimens consist of a combination of medical and surgical modalities, tailored to individual responses. However, HS is often refractory to traditional treatments, prompting the need for newer and more effective therapies. Herein, we review current and emerging HS therapies.
Topics: Humans; Hidradenitis Suppurativa; Dermatitis
PubMed: 38574201
DOI: No ID Found -
Archives of Gerontology and Geriatrics Aug 2023Nearly a third of US nursing home residents have diabetes mellitus. These residents have an increased risk of pressure ulcer (PU) development and progression; however,...
INTRODUCTION
Nearly a third of US nursing home residents have diabetes mellitus. These residents have an increased risk of pressure ulcer (PU) development and progression; however, little is known about the characteristics of their PUs or the role of other risk factors. This study estimates the prevalence of PUs, describes characteristics of PUs, and quantifies associations between risk factors and PUs in nursing home residents with diabetes.
METHODS
We conducted a cross-sectional study of nursing home residents aged ≥50 years with diabetes mellitus using national 2016 Minimum Data Set 3.0 data. Pressure ulcers were defined as the presence of any stage PU and by subgroups of stage and tissue type. Prevalence estimates of PUs were calculated overall and by covariate subgroups. Unadjusted and adjusted odds ratios were calculated using logistic regression.
RESULTS
The prevalence of any unhealed PU was 8.1%. Of those with a PU, 19.4% had at least two ulcers and the most common subtypes were identified as unstageable and stage 2 ulcers. These were most often treated by pressure reducing devices. In our fully adjusted model, risk factors that were strongly associated with PUs were related to mobility, nutrition, incontinence, and infections.
CONCLUSION
We observed that the prevalence of PUs remains high in nursing home residents with diabetes and that higher stage ulcers were common in this population. Our adjusted model highlights the importance of suspected risk factors in the development of PUs. Further research is needed to understand the unique needs of nursing home residents with diabetes.
Topics: Humans; Pressure Ulcer; Nursing Homes; Ulcer; Cross-Sectional Studies; Diabetes Mellitus; Prevalence; Suppuration
PubMed: 37004252
DOI: 10.1016/j.archger.2023.104969 -
International Journal of Molecular... Jul 2023Polyurethane (PU) refers to the polymer containing carbamate groups in its molecular structure, generally obtained by the reaction of isocyanate and alcohol. Because of... (Review)
Review
Polyurethane (PU) refers to the polymer containing carbamate groups in its molecular structure, generally obtained by the reaction of isocyanate and alcohol. Because of its flexible formulation, diverse product forms, and excellent performance, it has been widely used in mechanical engineering, electronic equipment, biomedical applications, etc. Through physical or chemical methods, ionic groups are introduced into PU, which gives PU electrical conductivity, flame-retardant, and antistatic properties, thus expanding the application fields of PU, especially in flexible devices such as sensors, actuators, and functional membranes for batteries and gas absorption. In this review, we firstly introduced the characteristics of PU in chemical and microphase structures and their related physical and chemical performance. To improve the performance of PU, ionic liquids (ILs) were applied in the processing or synthesis of PU, resulting in a new type of PU called ionic PU. In the following part of this review, we mainly summarized the fabrication methods of IL-modified PUs via physical blending and the chemical copolymerization method. Then, we summarized the research progress of the applications for IL-modified PUs in different fields, including sensors, actuators, transistors, antistatic films, etc. Finally, we discussed the future development trends and challenges faced by IL-modified PUs.
Topics: Humans; Polyurethanes; Ionic Liquids; Polymers; Molecular Structure; Suppuration
PubMed: 37511385
DOI: 10.3390/ijms241411627 -
Archives of Dermatological Research Sep 2023Drainage from chronic wounds can significantly negatively impact a patient's quality of life. Change in severity of wound drainage is an important measure of treatment... (Review)
Review
Drainage from chronic wounds can significantly negatively impact a patient's quality of life. Change in severity of wound drainage is an important measure of treatment efficacy for wounds. This study reviews existing tools used to assess wound drainage. Qualitative drainage tools are overall less burdensome, and however, differences in user interpretation may reduce inter-rater reliability. Quantitative drainage tools enable more reliable comparisons of drainage severity and treatment response between patients but sometimes require equipment to administer, increasing responder burden. Gaps in the current wound drainage measurement landscape are highlighted. Many of the existing scales have not been validated in robust studies. There is also a lack of validated global drainage measurement tools for patients with chronic inflammatory skin disorders with drainage, such as hidradenitis suppurativa or pyoderma gangrenosum. Development of a succinct drainage measurement tool for inflammatory skin diseases where drainage is a prominent symptom will improve monitoring of meaningful treatment response.
Topics: Humans; Quality of Life; Reproducibility of Results; Hidradenitis Suppurativa; Drainage; Treatment Outcome
PubMed: 36680593
DOI: 10.1007/s00403-023-02525-5