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Samimi S, Abbasi S, Taheri A, Farsaei S. The Topical Formulation of Whey Protein for the Prevention of Pressure Ulcers in Critically Ill Patients: A Novel Intervention in a Randomized-Controlled Clinical Trial. Adv Biomed Res 2023; 12:168. [PMID: 37564458 PMCID: PMC10410423 DOI: 10.4103/abr.abr_302_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/19/2022] [Accepted: 12/26/2022] [Indexed: 08/12/2023] Open
Abstract
Background High prevalence of pressure ulcers (PUs) and their complications are important dilemmas in the intensive care unit (ICU). Therefore this study was designed to evaluate the effectiveness of topical whey protein formulation in preventing PUs in patients admitted to the ICU. Materials and Methods In this randomized placebo-controlled clinical trial under registration number [IRCTdeted for blinded article], 80 eligible ICU patients were randomly allocated to receive topical ointment of whey protein or placebo on the sacrum with a diameter of 15 cm twice daily for seven days, in addition to the routine care. The mean risk score for developing PUs was calculated at baseline using the Braden tool, and the PUSH score was used to assess PUs on days 4, 7, and 14. Patients' related demographic and clinical variables were also collected using a medical record for more evaluation. Results Our results showed that demographic characteristics and the Braden scores' baseline mean were not significantly different between groups (P > 0.05). The repeated measures ANOVA test revealed that the mean scores of PUs at various times were markedly lower in the whey protein than in the placebo group (P < 0.001). Conclusion This intervention can be routinely added as effective, safe, inexpensive, and accessible care to reduce the incidence of PUs for patients at risk of developing this injury.
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Affiliation(s)
- Soroush Samimi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Abbasi
- Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Taheri
- Department of Pharmaceutics, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Farsaei
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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2
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Deng X, Gould M, Ali MA. A review of current advancements for wound healing: Biomaterial applications and medical devices. J Biomed Mater Res B Appl Biomater 2022; 110:2542-2573. [PMID: 35579269 PMCID: PMC9544096 DOI: 10.1002/jbm.b.35086] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/12/2022]
Abstract
Wound healing is a complex process that is critical in restoring the skin's barrier function. This process can be interrupted by numerous diseases resulting in chronic wounds that represent a major medical burden. Such wounds fail to follow the stages of healing and are often complicated by a pro‐inflammatory milieu attributed to increased proteinases, hypoxia, and bacterial accumulation. The comprehensive treatment of chronic wounds is still regarded as a significant unmet medical need due to the complex symptoms caused by the metabolic disorder of the wound microenvironment. As a result, several advanced medical devices, such as wound dressings, wearable wound monitors, negative pressure wound therapy devices, and surgical sutures, have been developed to correct the chronic wound environment and achieve skin tissue regeneration. Most medical devices encompass a wide range of products containing natural (e.g., chitosan, keratin, casein, collagen, hyaluronic acid, alginate, and silk fibroin) and synthetic (e.g., polyvinyl alcohol, polyethylene glycol, poly[lactic‐co‐glycolic acid], polycaprolactone, polylactic acid) polymers, as well as bioactive molecules (e.g., chemical drugs, silver, growth factors, stem cells, and plant compounds). This review addresses these medical devices with a focus on biomaterials and applications, aiming to deliver a critical theoretical reference for further research on chronic wound healing.
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Affiliation(s)
- Xiaoxuan Deng
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Maree Gould
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Azam Ali
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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3
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Goder D, Eshkol-Yogev I, Matsliah L, Lemberger M, Harlev M, Furer A, Zilberman M, Egozi D. In vivo study of the efficacy of bupivacaine-eluting novel soy protein wound dressings in a rat burn model. Burns 2022; 48:623-632. [PMID: 34330581 DOI: 10.1016/j.burns.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
Dealing with wound related pain is an integral part of treatment. Systemic administration of analgesic and anesthetic agents is a common solution for providing pain relief to patients but comes at a risk of severe side effects as well as addiction. To overcome these issues, research efforts were madeto provide a platform for local controlled release of pain killers. We have developed a bilayer soy protein-based wound dressing for the controlled local release of bupivacaine to the wound site. The combination of a dense and a porous layer provides a platform for cell growth and proliferation as well as physical protection to the wound site. The current study focuses on the in vitro bupivacaine release profile from the dressing and the corresponding in vivo results of pain levels in a second-degree burn model on rats. The Rat Grimace Scale method and the Von Frey filaments method were used to quantify both, spontaneous pain and mechanically induced pain. A high burst release of 61.8 ± 1.9% of the loaded drug was obtained during the initial hour, followed by a slower release rate during the following day. The animal trials show that the RGS scores of the bupivacaine-treated group were significantly lower than these of the untreated group, proving a decrease of 51-68% in pain levels during days 1-3 after burn. Hence, successful pain reduction of spontaneous pain as well as mechanically induced pain, for at least three days after burn was achieved. It is concluded that our novel bupivacaine eluting soy protein wound dressings are a promising new concept in the field of local controlled drug release for pain management.
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Affiliation(s)
- Daniella Goder
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Inbar Eshkol-Yogev
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Matsliah
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Moran Lemberger
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Mickey Harlev
- Veterinary Service Center, Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel Furer
- Medical Corps, Israel Defense Forces, Israel
| | - Meital Zilberman
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel; Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Dana Egozi
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
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4
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Laurano R, Boffito M, Ciardelli G, Chiono V. Wound Dressing Products: a Translational Investigation from the Bench to the Market. ENGINEERED REGENERATION 2022. [DOI: 10.1016/j.engreg.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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5
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Goder D, Giladi S, Furer A, Zilberman M. Bupivacaine-eluting soy protein structures for controlled release and localized pain relief: An in vitro and in vivo study. J Biomed Mater Res A 2021; 109:1681-1692. [PMID: 33728803 DOI: 10.1002/jbm.a.37163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
Burn pain is known to be excruciating, and while burn care has greatly advanced, treatment for burn-related pain is lacking. Current pain relief methods include systemic administration of analgesics, which does not provide high drug concentration at the wound site. In the present study, soy protein was used as the base material for bupivacaine-loaded hybrid wound dressings. The effect of the formulation on the drug release profile was studied using high performance liquid chromatography, and the cytotoxicity was tested on human fibroblasts. A second-degree burn model in rats was used to quantify the efficacy of the wound dressings in vivo, using the Rat Grimace Scale. All tested films exhibited high biocompatibility, and the drug release profiles showed rapid release during the initial 5 hr and a continuous slower release for another 24 hr. Significant pain relief was achieved in the animal trials, proving a decrease of 51-68% in pain levels during days 1-3 post-burn. Hence, the results indicate a safe and controlled bupivacaine release for a period of more than 24 hr, effectively treating pain caused by second-degree burns. The understanding of the formulation-properties effects, together with our in vivo study, enables to advance this field toward tailorable systems with high therapeutic potential.
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Affiliation(s)
- Daniella Goder
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Shir Giladi
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Furer
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Meital Zilberman
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Matsliah L, Goder D, Giladi S, Zilberman M. In vitro characterization of novel multidrug-eluting soy protein wound dressings. J Biomater Appl 2020; 35:978-993. [PMID: 33269628 DOI: 10.1177/0885328220975178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Polymers derived from natural sources are of interest in the scientific and medical communities, especially soy protein which exhibits low immunogenicity and good mechanical properties, and supports cell proliferation. Soy protein is cost-effective compared to other natural polymers and is attractive also due to its non-animal origin and relatively long storage stability. In the current study, hybrid film structures were developed and studied as a novel wound dressing platform with controlled release of three bioactive agents. The dense top layer is designed to provide mechanical support, control the water vapor permeability and to elute the antibiotic drug cloxacillin and the analgesic drug bupivacaine to the wound site. The porous sub-layer is designed to absorb the wound exudates and release the hemostatic agent tranexamic acid for bleeding control. The results show that the formulation parameters, i.e. crosslinker and plasticizer concentrations, affected the mechanical properties of the wound dressings as well as relevant physical properties (water vapor transmission rate and swelling kinetics), but had almost no effect on the drug-release profiles. While the antibiotic drug and the analgesic drug were released within several hours, the hemostatic agent was released within several minutes, according to the well designed hybrid structure. In conclusion, our novel soy protein hybrid wound dressings are biocompatible, can deliver various drugs simultaneously in a controlled fashion for each drug individually, and can be adjusted to suit various types of wounds by altering their properties through formulation effects.
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Affiliation(s)
- Lior Matsliah
- Faculty of Engineering, Tel Aviv University Iby and Aladar Fleischman, Tel Aviv, Israel
| | - Daniella Goder
- Faculty of Engineering, Tel Aviv University Iby and Aladar Fleischman, Tel Aviv, Israel
| | - Shir Giladi
- Faculty of Engineering, Tel Aviv University Iby and Aladar Fleischman, Tel Aviv, Israel
| | - Meital Zilberman
- Faculty of Engineering, Tel Aviv University Iby and Aladar Fleischman, Tel Aviv, Israel
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Abstract
GENERAL PURPOSE To present a comprehensive review of lymphedema, including its pathophysiology, assessment, diagnosis, and treatment. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Summarize the etiology, pathophysiology, and clinical manifestations of lymphedema.2. Describe the diagnostic and treatment approaches for patients who have lymphedema. ABSTRACT Lymphedema is a condition characterized by localized protein-rich swelling caused by damaged or malfunctioning lymphatics. Patients with lymphedema have an increased risk of infection because of the lymphostatic nature of the disease. Chronic ulceration of the skin can make individuals vulnerable to infection leading to serious, sometimes fatal, complications. Proper diagnosis and treatment modalities can aid in the prevention of these complications and ensure better outcomes for the patient.
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Topical Analgesic and Local Anesthetic Agents for Pain Associated with Chronic Leg Ulcers: A Systematic Review. Adv Skin Wound Care 2020; 33:240-251. [DOI: 10.1097/01.asw.0000658572.14692.fb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Goder D, Matsliah L, Giladi S, Reshef-Steinberger L, Zin I, Shaul A, Zilberman M. Mechanical, physical and biological characterization of soy protein films loaded with bupivacaine for wound healing applications. INT J POLYM MATER PO 2020. [DOI: 10.1080/00914037.2020.1716226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Daniella Goder
- Department of Materials Science and Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Lior Matsliah
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Shir Giladi
- Department of Materials Science and Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Idan Zin
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Shaul
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Meital Zilberman
- Department of Materials Science and Engineering, Tel-Aviv University, Tel-Aviv, Israel
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
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10
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Djekic L, Martinović M, Ćirić A, Fraj J. Composite chitosan hydrogels as advanced wound dressings with sustained ibuprofen release and suitable application characteristics. Pharm Dev Technol 2019; 25:332-339. [DOI: 10.1080/10837450.2019.1701495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ljiljana Djekic
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Martina Martinović
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ana Ćirić
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jadranka Fraj
- Department of Biotechnology and Pharmaceutical Engineering, University of Novi Sad, Novi Sad, Serbia
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12
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Bolton L. Peripheral arterial disease: Scoping review of patient-centred outcomes. Int Wound J 2019; 16:1521-1532. [PMID: 31597226 DOI: 10.1111/iwj.13232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 01/13/2023] Open
Abstract
Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD.
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Affiliation(s)
- Laura Bolton
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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13
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Eroglu I, Gultekinoglu M, Bayram C, Erikci A, Ciftci SY, Ayse Aksoy E, Ulubayram K. Gel network comprising UV crosslinked PLGA-b-PEG-MA nanoparticles for ibuprofen topical delivery. Pharm Dev Technol 2019; 24:1144-1154. [PMID: 31298072 DOI: 10.1080/10837450.2019.1643880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ibuprofen is a non-steroidal anti-inflammatory drug for the treatment of Rheumatoid Arthritis and osteoarthritis. In this study, we prepared topical gel network for enhancement of ibuprofen penetration, maintenance of controlled release and increased patient compliance. Nanoparticles containing ibuprofen were prepared by means of emulsion formation/solvent diffusion method using synthesized copolymer. Nanoparticles were then conjugated with aminoethylmethacrylate, resulting in ibuprofen-loaded nanoparticles in PLGA-b-PEG-MA structure. Ibuprofen-loaded gel networks were developed by crosslinking nanoparticles via UV exposure. Suitability for topical application has been assessed through characterization of particle size, zeta potential, morphology, encapsulation efficiency, in vitro release, cytotoxicity and enhancement of in vitro wound healing. The mean diameter of nanoparticles was measured as 230 ± 20 nm. Gel network formulations with higher particle size (2800 ± 350 nm) and zeta potential (39.8 ± 9.2 mV), depending on conjugation of methacrylate within copolymeric structure, and having encapsulation efficacy of 73.6 ± 2.8% were prepared. The in vitro release of ibuprofen was sustained for more than 7 hours. Gel network improved collagen synthesis, type I collagen mRNA expression and fibrosis in dose dependent manner. Based on this, we can conclude that PLGA-b-PEG gel network might be a promising systems for the local delivery of ibuprofen in RA patients.
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Affiliation(s)
- Ipek Eroglu
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Merve Gultekinoglu
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey.,Bioengineering Division, Institute for Graduate Studies in Science & Engineering, Hacettepe University , Ankara , Turkey
| | - Cem Bayram
- Advanced Technologies Application and Research Center, Hacettepe University , Ankara , Turkey
| | - Acelya Erikci
- Department of Biochemistry, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | | | - Eda Ayse Aksoy
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Kezban Ulubayram
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey.,Bioengineering Division, Institute for Graduate Studies in Science & Engineering, Hacettepe University , Ankara , Turkey
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Zhao X, Guo B, Wu H, Liang Y, Ma PX. Injectable antibacterial conductive nanocomposite cryogels with rapid shape recovery for noncompressible hemorrhage and wound healing. Nat Commun 2018; 9:2784. [PMID: 30018305 PMCID: PMC6050275 DOI: 10.1038/s41467-018-04998-9] [Citation(s) in RCA: 591] [Impact Index Per Article: 98.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/04/2018] [Indexed: 01/06/2023] Open
Abstract
Developing injectable antibacterial and conductive shape memory hemostatic with high blood absorption and fast recovery for irregularly shaped and noncompressible hemorrhage remains a challenge. Here we report injectable antibacterial conductive cryogels based on carbon nanotube (CNT) and glycidyl methacrylate functionalized quaternized chitosan for lethal noncompressible hemorrhage hemostasis and wound healing. These cryogels present robust mechanical strength, rapid blood-triggered shape recovery and absorption speed, and high blood uptake capacity. Moreover, cryogels show better blood-clotting ability, higher blood cell and platelet adhesion and activation than gelatin sponge and gauze. Cryogel with 4 mg/mL CNT (QCSG/CNT4) shows better hemostatic capability than gauze and gelatin hemostatic sponge in mouse-liver injury model and mouse-tail amputation model, and better wound healing performance than Tegaderm™ film. Importantly, QCSG/CNT4 presents excellent hemostatic performance in rabbit liver defect lethal noncompressible hemorrhage model and even better hemostatic ability than Combat Gauze in standardized circular liver bleeding model.
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Affiliation(s)
- Xin Zhao
- Frontier Institute of Science and Technology and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, 710049, Xi'an, China
| | - Baolin Guo
- Frontier Institute of Science and Technology and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Hao Wu
- Department of Orthopaedics, the First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Yongping Liang
- Frontier Institute of Science and Technology and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, 710049, Xi'an, China
| | - Peter X Ma
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Biologic and Materials Sciences, University of Michigan, 1011, North University Ave., Room 2209, Ann Arbor, MI, 48109, USA.
- Macromolecular Science and Engineering Center, University of Michigan, Ann Arbor, MI48109, USA.
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16
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Salomé GM, Ferreira LM. Impact of non-adherent Ibuprofen foam dressing in the lives of patients with venous ulcers. ACTA ACUST UNITED AC 2018; 44:116-124. [PMID: 28658329 DOI: 10.1590/0100-69912017002002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/15/2016] [Indexed: 01/10/2023]
Abstract
Objective to evaluate pain in patients with lower limb venous ulcer who used non-adherent Ibuprofen foam dressing (IFD). Methods we conducted a prospective study of patients with lower limb venous ulcers treated from April 2013 to August 2014. We used the Numerical Scale and McGill Pain Questionnaire, performing the assessments at the moment of inclusion of the patient in the study and every eight days thereafter, totaling five consultations. We divided the patients into two groups: 40 in the Study Group (SG), who were treated with IFD, and 40 in the Control Group (CG), treated with primary dressing, according to tissue type and exudate. Results at the first consultation, patients from both groups reported intense pain. On the fifth day, SG patients reported no pain and the majority of CG reported moderate pain. Regarding the McGill Pain Questionnaire, most patients of both groups reported sensations related to sensory, affective, evaluative and miscellaneous descriptors at the beginning of data collection; after the second assessment, there was slight improvement among the patients in the SG. After the third consultation, they no longer reported the mentioned descriptors. CG patients displayed all the sensations of these descriptors until the fifth visit. Conclusion non-adherent Ibuprofen foam dressing is effective in reducing the pain of patients with venous ulcers.
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Affiliation(s)
- Geraldo Magela Salomé
- - Sapucaí Valley University, Professional Master's Degree in Applied Health Sciences, Pouso Alegre, MG, Brazil
| | - Lydia Masako Ferreira
- - Sapucaí Valley University, Professional Master's Degree in Applied Health Sciences, Pouso Alegre, MG, Brazil
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Vinklárková L, Masteiková R, Foltýnová G, Muselík J, Pavloková S, Bernatonienė J, Vetchý D. Film wound dressing with local anesthetic based on insoluble carboxymethycellulose matrix. J Appl Biomed 2017. [DOI: 10.1016/j.jab.2017.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Palliative Care in the Management of Pain, Odor, and Exudate in Chronic Wounds at the End of Life. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Madisetti M, Kelechi TJ, Mueller M, Amella EJ, Prentice MA. Feasibility, acceptability, and tolerability of RGN107 in the palliative wound care management of chronic wound symptoms. J Wound Care 2017; 26:S25-S34. [PMID: 28105900 PMCID: PMC10580812 DOI: 10.12968/jowc.2017.26.sup1.s25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To assess the feasibility, acceptability and tolerability of RGN107 use, a natural powder blend of Arnica Montana, Calendula Officinalis, Mentha Arvensis and Santalum Album, among hospice patients and their wound caregivers in the palliative wound care management of chronic wound symptoms at end-of-life. METHOD Data were collected between May 2013 and November 2015. A pilot trial conducted among 50 hospice patients with symptomatic (pain, odour, or exudate) chronic wounds. Caregivers received initial RGN107 protocol training, actively applied the powder to patient wounds for 4-weeks, and completed an 8-week retrospective survey. Feasibility was assessed by measuring process outcomes, including the number and proportion of participants referred, screened eligible, enrolled, withdrawn and successfully completed. Acceptability measures included: a protocol training evaluation, caregiver pre and post self-efficacy ratings, retrospective usability, symptom control management and comparative technique caregiver ratings, and recorded open-ended comments. Tolerability was assessed through a 12-week cumulative review of the study adverse event profile. RESULTS Feasibility, tolerability and acceptability of use of the RGN107 powder for chronic wounds were established. Recruitment goals were achieved and 92 % of the patients successfully completed the study. 95 % of wound caregivers would recommend the powder for use in this population. CONCLUSION This study supports the feasibility, acceptability and tolerability of a wound care powder that espouses a multi-symptom palliative comfort care approach for hospice patients with chronic wounds at end-of-life. Further research is needed to establish the efficacy of the powder.
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Affiliation(s)
- M Madisetti
- Project Director, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - T J Kelechi
- Professor and David and Margaret Clare Endowed Chair, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - M Mueller
- Associate Professor, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - E J Amella
- Professor, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
| | - M A Prentice
- Research Coordinator, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston SC 29425
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Macro-scale model study of a tunable drug dispensation mechanism for controlled drug delivery in potential wound-healing applications. J Appl Biomater Funct Mater 2016; 15:e63-e69. [PMID: 28058697 DOI: 10.5301/jabfm.5000280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Auxetic materials tend to exhibit stretching in the direction of the applied load as well as in the perpendicular direction. This may be an inherent property of the material, or it might be a particular structural characteristic that confers it with auxetic properties. In this study, the auxetic properties of a rotating squares auxetic design were utilized in tandem with a stretching mechanism to manufacture a device that offers the advantages of adjustable pore size and hence tunable drug delivery characteristics. METHODS An auxetic polyurethane film was fabricated through the polymer casting technique. An acrylonitrile-butadiene-styrene (ABS) plastic mold for polymer casting was made through additive manufacturing. Stereolithography was used for fabrication of the mechanism that controlled pore size of the polymeric auxetic film. A laminate arrangement of the film and the mechanism was devised, through which movement of the mechanism controlled stretching of the auxetic film underneath. RESULTS Results were analyzed through image processing. It was observed that a 2-dimensional increase (in length and width) of the auxetic film took place that corresponded to an increase in pore size of the film. Several mathematical correlations were drawn up. CONCLUSIONS It may be concluded that the first factor controlling drug release kinetics is the pore size of the film. This study explored a prototype mechanism that has the potential for being used in devices for controlled drug delivery or in smart bandage systems that may enhance wound healing in chronic wound treatment.
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Boateng J, Catanzano O. Advanced Therapeutic Dressings for Effective Wound Healing--A Review. J Pharm Sci 2015; 104:3653-3680. [PMID: 26308473 DOI: 10.1002/jps.24610] [Citation(s) in RCA: 470] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/15/2022]
Abstract
Advanced therapeutic dressings that take active part in wound healing to achieve rapid and complete healing of chronic wounds is of current research interest. There is a desire for novel strategies to achieve expeditious wound healing because of the enormous financial burden worldwide. This paper reviews the current state of wound healing and wound management products, with emphasis on the demand for more advanced forms of wound therapy and some of the current challenges and driving forces behind this demand. The paper reviews information mainly from peer-reviewed literature and other publicly available sources such as the US FDA. A major focus is the treatment of chronic wounds including amputations, diabetic and leg ulcers, pressure sores, and surgical and traumatic wounds (e.g., accidents and burns) where patient immunity is low and the risk of infections and complications are high. The main dressings include medicated moist dressings, tissue-engineered substitutes, biomaterials-based biological dressings, biological and naturally derived dressings, medicated sutures, and various combinations of the above classes. Finally, the review briefly discusses possible prospects of advanced wound healing including some of the emerging physical approaches such as hyperbaric oxygen, negative pressure wound therapy and laser wound healing, in routine clinical care.
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Affiliation(s)
- Joshua Boateng
- Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK.
| | - Ovidio Catanzano
- Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK
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Formulation of Novel Layered Sodium Carboxymethylcellulose Film Wound Dressings with Ibuprofen for Alleviating Wound Pain. BIOMED RESEARCH INTERNATIONAL 2015; 2015:892671. [PMID: 26090454 PMCID: PMC4450273 DOI: 10.1155/2015/892671] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/02/2014] [Indexed: 11/18/2022]
Abstract
Effective assessment and management of wound pain can facilitate both improvements in healing rates and overall quality of life. From a pharmacological perspective, topical application of nonsteroidal anti-inflammatory drugs in the form of film wound dressings may be a good choice. Thus, the aim of this work was to develop novel layered film wound dressings containing ibuprofen based on partially substituted fibrous sodium carboxymethylcellulose (nonwoven textile Hcel NaT). To this end, an innovative solvent casting method using a sequential coating technique has been applied. The concentration of ibuprofen which was incorporated as an acetone solution or as a suspension in a sodium carboxymethylcellulose dispersion was 0.5 mg/cm2 and 1.0 mg/cm2 of film. Results showed that developed films had adequate mechanical and swelling properties and an advantageous acidic surface pH for wound application. An in vitro drug release study implied that layered films retained the drug for a longer period of time and thus could minimize the frequency of changing the dressing. Films with suspended ibuprofen demonstrated higher drug content uniformity and superior in vitro drug release characteristics in comparison with ibuprofen incorporation as an acetone solution. Prepared films could be potential wound dressings for the effective treatment of wound pain in low exuding wounds.
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Erfurt-Berge C, Renner R. Recent developments in topical wound therapy: impact of antimicrobiological changes and rebalancing the wound milieu. BIOMED RESEARCH INTERNATIONAL 2014; 2014:819525. [PMID: 24829919 PMCID: PMC4009310 DOI: 10.1155/2014/819525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/15/2014] [Accepted: 03/15/2014] [Indexed: 11/17/2022]
Abstract
Wound therapy improves every year by developing new wound treatment options or by advancing already existing wound materials, for example, adding self-releasing analgesic drugs or growth factors to wound dressings, or by binding and inactivating excessive proteases. Also new dressing materials based on silk fibers and enhanced methods to reduce bacterial burden, for example, cold argon plasma, might help to fasten wound healing.
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Affiliation(s)
- Cornelia Erfurt-Berge
- Hautklinik Erlangen, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Regina Renner
- Hautklinik Erlangen, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
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Shemesh M, Zilberman M. Structure-property effects of novel bioresorbable hybrid structures with controlled release of analgesic drugs for wound healing applications. Acta Biomater 2014; 10:1380-91. [PMID: 24316366 DOI: 10.1016/j.actbio.2013.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/19/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
Over the last decades, wound dressings have developed from the traditional gauze dressing to tissue-engineered scaffolds. A wound dressing should ideally maintain a moist environment at the wound surface, allow gas exchange, act as a barrier to micro-organisms and remove excess exudates. In order to provide these characteristics, we developed and studied bioresorbable hybrid structures which combine a synthetic porous drug-loaded top layer with a spongy collagen sublayer. The top layer, prepared using the freeze-drying of inverted emulsions technique, was loaded with the analgesic drugs ibuprofen or bupivacaine, for controlled release to the wound site. Our investigation focused on the effects of the emulsion's parameters on the microstructure and on the resulting drug-release profile, as well as on the physical and mechanical properties. The structure of the semi-occlusive top layer enables control over vapor transmission, in addition to strongly affecting the drug release profile. Release of the analgesic drugs lasted from several days to more than 100 days. Higher organic:aqueous phase ratios and polymer contents reduced the burst release of both drugs and prolonged their release due to a lower porosity. The addition of reinforcing fibers to this layer improved the mechanical properties. Good binding of the two components, PDLGA and collagen, was achieved due to our special method of preparation, which enables a third interfacial layer in which both materials are mixed to create an "interphase". These new PDLGA/collagen structures demonstrated a promising potential for use in various wound healing applications.
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The range and role of palliative interventions for locally advanced breast cancer. Curr Opin Support Palliat Care 2014; 8:70-6. [DOI: 10.1097/spc.0000000000000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Current World Literature. Curr Opin Support Palliat Care 2013; 7:116-28. [DOI: 10.1097/spc.0b013e32835e749d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Venous leg ulcers affect up to 1% of people at some time in their lives and are often painful. The main treatments are compression bandages and dressings. Topical treatments to reduce pain during and between dressing changes are sometimes used. OBJECTIVES To determine the effects of topical agents or dressings for pain in venous leg ulcers. SEARCH METHODS For this third update the following databases were searched: Cochrane Wounds Group Specialised Register (searched 9 May 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4); Ovid MEDLINE (2009 to April Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations May 08, 2012); Ovid EMBASE (2009 to 2012 Week 18); and EBSCO CINAHL (2009 to May 2 2012). No date or language restrictions were applied. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of topical agents or dressing for the treatment of pain in venous ulcers were included. DATA COLLECTION AND ANALYSIS Two review authors independently performed trial selection, data extraction and risk of bias assessment. MAIN RESULTS Six trials (343 participants) evaluated Eutectic Mixture of Local Anaesthetics (EMLA): lidocaine-prilocaine cream for the pain associated with ulcer debridement. The between-group difference in pain measured on a 100 mm scale was statistically significant in favour of EMLA (MD -20.65, 95% CI -12.19 to -29.11). No significant between-group differences in burning or itching were observed.Two trials (470 participants with venous leg ulcers) evaluated ibuprofen slow-release foam dressings for persistent venous leg ulcer pain. Compared with local best practice, significantly more participants in the ibuprofen dressing group achieved the outcome of >50% of the total maximum pain relief score between day 1 and day 5 than participants in the local best practice group (RR 1.63, 95% CI 1.24 to 2.15). The number needed to treat was 6 (95% CI 4 to 12). In the second trial, compared with an identical non-ibuprofen foam dressing, there was no statistically significant difference in the proportion of participants experiencing slight to complete pain relief on the first evening of treatment.Limited data were available to assess healing rates or adverse events. AUTHORS' CONCLUSIONS There is some evidence to suggest that ibuprofen dressings may offer pain relief to people with painful venous leg ulcers. EMLA (5%) appears to provide effective pain relief during the debridement of venous leg ulcers. Further research should consider standardised pain assessment methods and assess both the effect on ulcer healing and the impact of long term use of these treatments.
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Fogh K, Andersen MB, Bischoff-Mikkelsen M, Bause R, Zutt M, Schilling S, Schmutz JL, Borbujo J, Jimenez JA, Cartier H, Jørgensen B. Clinically relevant pain relief with an ibuprofen-releasing foam dressing: results from a randomized, controlled, double-blind clinical trial in exuding, painful venous leg ulcers. Wound Repair Regen 2012; 20:815-21. [PMID: 23110444 DOI: 10.1111/j.1524-475x.2012.00844.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/19/2012] [Indexed: 11/30/2022]
Abstract
The objective of this 6-week, 120-patient, double-blind, randomized, controlled trial was to investigate if a foam dressing with ibuprofen provided clinically relevant pain relief (PAR) for exuding, painful venous leg ulcers in comparison with a similar foam dressing without ibuprofen. Primary outcome parameter was PAR compared with baseline pain during the first 5 days of the investigation. PAR was registered by the patient morning and evening. Main end point was proportion of patients reporting a summed PAR score of at least 50% of the total maximum PAR (i.e., responders) and the corresponding number needed to treat (NNT). Wound-related parameters such as ulcer healing, ulcer area reduction, and peri-ulcer skin condition as well as adverse events were recorded during all 6 weeks of the investigation. PAR was significantly greater in the ibuprofen foam group than the comparator group (p = 0.0438). There were 34% responders in the ibuprofen foam group vs. 19% in the comparator group (NNT = 6.8). When evening data were analyzed separately to evaluate PAR over daytime, NNT was 5.3. Wound healing parameters and adverse events were comparable. In conclusion, in this study, the ibuprofen foam dressing provided clinically relevant PAR for patients with exuding, painful venous ulcers.
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Affiliation(s)
- Karsten Fogh
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
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