The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.
- Klíčová slova
- Cold River,
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- mladý dospělý MeSH
- pacienti psychologie MeSH
- popálení * ošetřování psychologie terapie MeSH
- postoj zdravotnického personálu MeSH
- senioři MeSH
- terapie pomocí virtuální reality * metody přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- amputace MeSH
- dospělí MeSH
- infekce * chirurgie terapie MeSH
- lidé MeSH
- nekróza chirurgie terapie MeSH
- pokus o sebevraždu MeSH
- popálení elektrickým proudem * chirurgie komplikace MeSH
- poranění ruky chirurgie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- kazuistiky MeSH
Jedním z klíčových úkolů v terapii popálených pacientů je efektivní zvládání bolesti. Bolest spojenou s tepelným poškozením charakterizuje její komplexní charakter, tj. akutní, neuropatické, zánětlivé a nociceptivní vlastnosti. Jelikož bolest jako taková je spojena s celou řadou dalších negativních vjemů (zejména se strachem a úzkostí), vede nedostatečná kontrola bolestivých podnětů k poklesu „compliance“ pacientů a může zavinit delší hojení s jasným dopadem na kvalitu života nemocného. Lékem volby u rozsáhle popálených jsou opioidy. Jejich podávání ale musí brát v úvahu několik klíčových faktorů, mezi které patří stav vědomí nemocného, individuální vnímání bolesti, přidružené choroby a komplikace a chirurgický léčebný plán nebo délka hospitalizace. Ta může přesáhnout 5 a více měsíců. Během této doby se po opakovaném nebo kontinuálním podávání opioidů jejich účinnost výrazně snižuje. Jejich podávání je také zatíženo řadou nežádoucích účinků. Proto se doporučuje jejich kombinace s dalšími skupinami léků, jako jsou ketamin, nesteroidní antiflogistika (non-steroidal anti-inflammatory drugs, NSAID), paracetamol, pregabalin, anxiolytika a nefarmakologické postupy typu psychologické podpory, hypnózy, meditace, aromaterapie, virtuální reality a vhodné rehabilitace. Důležitá je také psychosociální podpora rodiny nemocného.
One of the primary difficulties in treating burn patients lies in efficacious pain management. Pain arising from thermal injury is amalgamated with a multifaceted composition, encompassing acute, neuropathic, inflammatory, and nociceptive traits. Inadequate management of painful stimuli leads to reduced patients' "compliance" and can prolong recovery times with a detrimental impact on the patient's quality of life, given pain's known association with negative perceptions such as fear and anxiety. Opioids are the preferred drug for treating extensive burns. However, administration must consider several crucial factors such as the patient's consciousness state, pain perception, associated diseases and complications, and the surgical treatment plan or hospital stay length, which may exceed five months or longer. The efficiency of opioids significantly declines after repeated or constant administration during this period. In addition, administering opioids results in several adverse effects. Therefore, it is advisable to integrate them with additional drug regimens like ketamine, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, pregabalin, anxiolytics, as well as non-pharmacological methods such as psychological support, hypnosis, meditation, aromatherapy, virtual reality, and appropriate rehabilitation. Psychosocial family support plays a crucial role as well.
Úvod: Staphylococcus aures (S. aureus) je grampozitívny fakultatívne anaeróbny kok, ktorý je schopný vyvolať infekčné ochorenie zvierat aj ľudí. Zvlášť nebezpečné sú multirezistentné formy s nižšou, alebo aj žiadnou odpoveďou na dostupnú liečbu. Ciele: Cieľom práce je overiť vplyv enzybiotík v hojení S. aureus infikovaných kožných rán na exprimentálnom modeli prasiat. Metodika: Do pokusu boli zaradené dve prasatá, ktorým boli na chrbtovej oblasti vyrezané rany (10x/1prasa) o veľkosti 5x5 cm s 2 cm odstupmi. Rany boli infikované methicilin (Oxacilin) a amoxicilin resistentným kmeňom S. aureus baktérie (MRSA). Experimentálne skupiny pozostávali z jednotlivých rán, ktoré boli infikované jedným sekvenčným typom baktérie S. aureus v koncentrácii 2x10 9 CFU/ml. Dve rany ostali neliečené (N), štyri rany boli liečené hydrogélom doplneným lyzostatínom (L) a štyri boli liečené hydrogélom doplneným lyzostatínom a endolyzínom (LE). Následne boli na štvrtý, siedmy, jedenásty a štrnásty deň odoberané vzorky z jednotlivých rán. Materiál bol spracovaný štandardnou histologickou technikou formou parafinových bločkov a rezy boli farbené hematoxylínom-eozínom. Výsledky: Z výsledkov vyplýva, že ide o defekty s celým spektrom reparačných zmien s reepitelizáciou so striedaním úsekov nekróz a novovytvoreného granulačného tkaniva s doprevádzajúcim guľatobunečným zápalovým infiltrátom na podklade edematózneho tkaniva a povrchovými chrastami. Na povrchu rán a tiež v menších skupinkách v novovytvorenom granulačnom tkanive sú viditeľné kokovitné útvary charakteru S. aureus. V hydrogélových krytoch, ktoré obsahujú lyzostafín, alebo kombináciu lyzostafínu s endolyzínom sa porovnaním s neliečenými ranami zachytávajú väčšie množstvá kolónie S. aureus kokov, ktoré tu vo veľkej miere následne odumierajú. Záver: Enzybiotiká môžu mať potenciál v topickej terapii MRSA infikovaných kožných rán.
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BACKGROUND: Specific toxic compounds, such as polycyclic aromatic hydrocarbons (PAHs) and their metabolites, may affect the inhalation injury (INHI) grade, patients' status, and prognosis for recovery. This pilot prospective study aimed to: i) evaluate the suitability of bronchoalveolar lavage (BAL) for determination of PAHs in the LRT and of urine for determination of hydroxylated metabolites (OH-PAHs) in patients with INHI, ii) describe the dynamic changes in the levels of these toxic compounds, and iii) correlate these findings with clinical variables of the patients with INHI. METHODS: The BAL and urine samples from 10 patients with INHI were obtained on Days 1, 3, 5, 7, and 14 of hospitalization, if possible, and PAHs (BAL) and OH-PAHs (urine) were analyzed using chromatographic methods (GC-MS and HPLC). RESULTS: Concentrations of analyzed PAHs were in most cases and time points below the limit of quantification in BAL samples. Nine OH-PAHs were detected in the urine samples; however, their concentrations sharply decreased within the first three days of the hospitalization. On Day 14, the total amount of OH-PAHs in urine was higher in surviving patients with High-grade INHI (≥3) than in those with Low-grade INHI (<3, p = 0.032). Finally, a significant correlation between certain OH-PAHs and clinical variables (AST/ALT, TBSA, ABSI) from Day 1 of the hospitalization was observed (p<0.05). CONCLUSIONS: BAL samples are not suitable for the analysis of PAHs. However, the OH-PAHs levels in urine can be measured reliably and were correlated with several clinical variables. Moreover, High-grade INHI was associated with higher total concentrations of OH-PAHs in urine.
- MeSH
- bronchoalveolární lavážní tekutina * chemie MeSH
- dospělí MeSH
- hospitalizace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- polycyklické aromatické uhlovodíky * moč analýza MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Pseudomonas aeruginosa poses a significant threat to both immunocompetent and immunocompromised individuals, often resulting in life-threatening infections. With increasing antimicrobial resistance, novel therapeutic strategies are urgently needed. Although animal models are crucial for preclinical studies, limited data are available for porcine models, more specifically for P. aeruginosa complicated skin and soft tissue infections (cSSTIs). This study presents a novel porcine model inducing and sustaining cSSTI for 14 days. Six pigs (120 wounds) were used for the development of infections, and within this group, two pigs (40 wounds) were used to evaluate the progression of the cSSTI infection. The model demonstrated bacterial loads of more than 107 CFU/gram of tissue or higher. The cSSTI fully developed within three days and remained well above these levels until day 14 post-infection. Due to the immunocompetence of this model, all the immunological processes associated with the response to the presence of infection and the wound healing process are preserved.
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.
- MeSH
- antifungální látky * terapeutické užití MeSH
- COVID-19 * imunologie komplikace MeSH
- dospělí MeSH
- fatální výsledek MeSH
- koinfekce mikrobiologie farmakoterapie imunologie MeSH
- lidé MeSH
- mykózy farmakoterapie mikrobiologie imunologie diagnóza MeSH
- nitrily terapeutické užití MeSH
- popálení komplikace mikrobiologie MeSH
- pyridiny terapeutické užití MeSH
- Saccharomycetales genetika účinky léků imunologie MeSH
- SARS-CoV-2 imunologie MeSH
- sepse farmakoterapie mikrobiologie imunologie MeSH
- triazoly terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Hidradenitis suppurativa (HS) je ťažko diagnostikovateľné ochorenie, ktoré často nereaguje na konvenčnú liečbu, čo spôsobuje, že terapia a manažment sú pre lekárov veľmi náročné. Možnosti liečby sa môžu líšiť v závislosti od štádia ochorenia. U každého pacienta sa doporučuje správna edukácia zahrňujúca možnosti konzervatívnej liečby, psychosociálnu podporu, možnosti tlmenia bolesti a ošetrenie supurujúcich prejavov s aplikáciou vhodného krytia. Zhľadiska minimalizácie recidív má svoje nezastupiteľné miesto chirurgická terapia a to v každom štádiu ochorenia. Multidisciplinárny prístup zahŕňajúci najmä dermatológa a plastického chirurga je kľúčom k rýchlej optimálnej kontrole ochorenia.
Hidradenitis suppurativa (HS) is difficult to diagnose and often refractory to conventional treatment which make its treatment and management very challenging for clinicians. The treatment option can vary according to the stage of the disease. For each patient, proper education is recommended, including options for conservative treatment, psychosocial support, options for pain relief, and treatment of suppurative manifestations with the application of appropriate wound coverage. To achieve minimal recurrence, surgical therapy has its place at every stage of the disease. A multidisciplinary approach including mainly dermatologist and plastic surgeon is key to prompt optimal disease control.
BACKGROUND: The purpose of dermal substitutes is to mimic the basic properties of the extracellular matrix of human skin. The application of dermal substitutes to the defect reduces the formation of hypertrophic scars and improves the scar quality. This study aims to develop an original dermal substitute enriched with stable fibroblast growth factor 2 (FGF2-STAB®) and test it in an animal model. METHODS: Dermal substitutes based on collagen/chitosan scaffolds or collagen/chitosan scaffolds with nanofibrous layer were prepared and enriched with FGF2-STAB® at concentrations of 0, 0.1, 1.0, and 10.0 μg ‧ cm-2. The performance of these dermal substitutes was tested in vivo on artificially formed skin defects in female swine. The outcomes were evaluated using cutometry at 3 and 6 months. In addition, visual appearance was assessed based on photos of the scars at 1-month, 3-month and 6-month follow-ups using Yeong scale and Visual Analog Scale. RESULTS: The dermal substitute was fully integrated into all defects and all wounds healed successfully. FGF2-STAB®-enriched matrices yielded better results in cutometry compared to scaffolds without FGF2. Visual evaluation at 1, 3, and 6 months follow-ups detected no significant differences among groups. The FGF2-STAB® effectiveness in improving the elasticity of scar tissues was confirmed in the swine model. This effect was independently observed in the scaffolds with nanofibres as well as in the scaffolds without nanofibres. CONCLUSION: The formation of scars with the best elasticity was exhibited by addition 1.0 μg ‧ cm-2of FGF2-STAB® into the scaffolds, although it had no significant effect on visual appearance at longer follow-ups. This study creates the basis for further translational studies of the developed product and its progression into the clinical phase of the research.
- MeSH
- chitosan * MeSH
- fibroblastový růstový faktor 2 * MeSH
- hojení ran účinky léků MeSH
- jizva hypertrofická MeSH
- kolagen MeSH
- kůže MeSH
- modely nemocí na zvířatech MeSH
- nanovlákna terapeutické užití MeSH
- popálení MeSH
- prasata MeSH
- pružnost * MeSH
- tkáňové podpůrné struktury MeSH
- umělá kůže * MeSH
- viskozita MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
