The therapeutic use of honey

Honey has been shown to have antibacterial activity against a variety of species of bacteria in vitro. Although the evidence regarding the use of honey for wound treatment in neonates and infants is interesting, it is not strong. The sample sizes in the cited clinical studies are small; there were no comparison groups and no randomization. It appears that honey may be safe and useful in treating difficult-to-heal infected wounds, but double-blinded randomized controlled clinical trials with sufficient power are needed to determine the efficacy of honey in both initial wound management and secondary treatment of infected and poorly healing wounds. A comparison of different types of honey would be an important component of these trials. Currently, there is not enough evidence to recommend one type of honey over another type; however, honey and wound care experts do recommend honey for wound care, not for consumption.     

Management of Pseudomonas osteochondritis complicating puncture wounds of the foot

Pseudomonas osteochondritis following puncture wounds of the foot is described in 13 children. All children had received at least one oral antibiotic and local wound therapy before admission; none had improved on these modalities. Pseudomonas aeruginosa was isolated alone from seven patients and with one or more other organisms from six patients. Initial administration of parenteral antibiotics active against Pseudomonas for one to 14 days did not result in clinical improvement. Eradication of Pseudomonas osteochondritis occurred in each patient only after thorough surgical debridement and curettage of all infected tissue. Following thorough surgical debridement, anti-Pseudomonas antibiotic therapy was continued for five to 14 days (10.8 +/- 2.7 days). The successful treatment of Pseudomonas osteochondritis should include adequate surgical debridement of all infected tissue; following thorough debridement, only one to two weeks of anti-Pseudomonas antibiotic therapy appears to be necessary.     

Prophylactic oral antibiotics for low-risk dog bite wounds.

The use of prophylactic antibiotics in the initial treatment of noninfected dog bite wounds is controversial. All patients with noninfected dog bite wounds who presented to our emergency department (ED) over a two-year period were considered for entry into a randomized prospective study. Patients were excluded from the study if they had any high-risk criteria for infection: puncture wounds, hand or foot wounds, wounds greater than 12 hours old, a history of immunocompromising disorders, or the use of immunosuppressive drugs. Patients in the antibiotic group (n = 89) were treated with local wound care and given either dicloxacillin, cephalexin, or erythromycin orally for seven days. Patients in the control group (n = 96) received local wound care only. All patients had their wounds irrigated with a 1% povidone-iodine solution and debrided and sutured if clinically indicated. All patients were subsequently reevaluated for clinical signs of wound infection. The groups were similar in age, sex, time of delay in seeking treatment, anatomic sites of wounds, depths and types of wounds, and number of wounds requiring suturing. The wound infection rates for the antibiotic and control groups were 1.1 and 5.1%, respectively. This difference was not significant (P = 0.212). There were 36 wounds in the antibiotic group and 37 wounds in the control group that were full thickness. The infection rates for these wounds were 2.8 and 13.5%, respectively. This was not statistically significant (P = 0.132). This study suggests that prophylactic oral antibiotics in low-risk dog bite wounds are not indicated.     

通过临床评估早期诊断早产儿院内感染的初步探讨

目的　探讨用临床表现及实验室检查评分的方法判断早产低出生体重儿院内细菌感染的可能性。方法　将研究对象按现行新生儿感染的诊断标准分为感染组 (A组 )及对照组 (B组 ) ,按照临床表现的严重程度及临床常用实验室检查结果予以综合性评分 ,并以有效抗生素治疗后进行对照 ,分别对组间及组内的评分进行比较。结果　治疗前 2 4hA组评分大于B组 ,两组评分之间差异有显著性 (P <0 0 1) ,有效抗生素治疗后A组与B组评分之间差异无显著性 (P >0 0 5 )。在A组治疗前与治疗后评分差异有显著性 (P <0 0 1)。B组中≥ 11分者在抗生素治疗后评分下降 ,并与治疗前比较差异有显著性 (P <0 0 1) ;<11分者差异无显著性。提示现行诊断新生儿感染的标准 ,对早产儿及胎龄小的极低出生体重儿不敏感。结论　对早产儿及低出生体重儿进行临床综合评分 ,有利于判断患儿感染的可能性 ,并可监测抗感染治疗的有效性。     

Mammalian bites. Review of evaluation and management

Mammalian bites account for a large number of emergency department and doctor's visits. Children are the victims in more than half of reported cases. Dogs account for the majority of wounds, and almost all fatalities in these cases are due to dog bites. Human bites and cat bites account for the majority of infected wounds. Basic wound care, combined with appropriate antibiotic coverage in high risk wounds, is the most important principle of management.     

The role of preoperative antibiotics in the prevention of wound infection after day case surgery for inguinal hernia in children in Ile Ife,Nigeria

Purpose  Day case surgery for inguinal hernia had been an established practice of the Paediatric Surgery Unit, OAUTHC, Ile Ife for about two decades. In a retrospective review of the practice from the same center, a high incidence of postoperative wound infection was noted, which was attributed to the poor personal hygiene of the patients. This prospective study, therefore, was performed to evaluate the role of a single dose of preoperative antibiotic (using gentamicin) in the prevention of these wound infections after day case surgery for inguinal hernia in children. Methods  This was a prospective study carried out over a period of 8 months from 11 April 2004 to 20 December 2004. During this period, 88 children aged from birth to 15 years were randomized into two groups of equal numbers to undergo elective inguinal herniotomy. The children in the test group received prophylactic intravenous gentamicin, 30 min before a groin crease incision was made, while those in the control group did not. All patients were subsequently followed up for 32 days for any evidence of a wound infection. Results  There were 104 wounds in the ratio of 50:54 in the control and test groups, respectively. All 54 wounds of the children who received prophylactic gentamicin healed primarily and without complication. Five cases of wound infections occurred in the control group, giving an infection rate of 4.8% (P < 0.041). Staphylococcus aureus was the single pathogen isolated from the infected postherniotomy wounds and this organism was wholly sensitive to gentamicin. Conclusion  From the findings in this study, administration of preoperative gentamicin has a role in the prevention of wound infection after day case surgery for inguinal hernias in susceptible children. Preoperative intravenous gentamicin is therefore recommended as a prophylactic measure against wound infection after day case surgery for inguinal hernias in those children at risk of wound infection.     

临床及实验室评估对早产儿医院感染早期诊断的意义

目的探讨临床评估及实验室检查对早产儿医院感染早期诊断的价值。方法制定早产儿感染评分表,选择2009年1月至2010年6月在菏泽市立医院新生儿病房住院及2010年7～12月在中国医科大学绍兴医院新生儿科住院的早产儿,在抗生素使用前及治疗5天时根据临床表现进行评分,同时在应用抗生素前进行实验室检查,分为败血症组、非败血症感染组(感染组)、非感染组(对照组),对不同组别、不同评分点评分的差异、临床表现、实验室检查的特异度、敏感度、误诊率、漏诊率、正确率、阳性似然比、阴性似然比进行统计学分析。结果败血症组(27例)初始评分最高(16.2±7.2)分,感染组(39例)其次(12.4±5.3)分,对照组(52例)最低(5.3±3.2)分,3组间差异有统计学意义(P<0.05);败血症组和感染组治疗后评分明显下降(7.3±3.9)分和(6.7±3.5)分,与对照组(5.2±3.0)分比较差异无统计学意义(P>0.05)。临床表现中反应低下、喂养困难、体温异常、皮肤循环差等对诊断有重要的预测价值,其中反应低下诊断价值最高;抗生素使用前的CRP和PCT阳性似然比较高(66.8%和72.5%),诊断价值最高,PLT有一定诊断价值。结论对早产儿进行临床评估是发现医院感染的基础,常规的实验室检查有助于早产儿医院感染的早期诊断。     

Treatment of respiratory failure in an infant with bronchopulmonary dysplasia infected with respiratory syncytial virus using inhaled nitric oxide and high frequency ventilation

A 2-month-old, former 28-week premature infant with brochopulmonary dysplasia infected with respiratory syncytial virus was treated with nitric oxide and high frequency oscillatory ventilation after conventional therapy failed. Nitric oxide and high frequency oscillatory ventilation rapidly improved oxygenation allowing recovery without the need for extracorporeal membrane oxygenation. This treatment regimen should be considered as an option in high-risk infants with respiratory syncytial virus infection who meet extracorporeal membrane oxygenation criteria.     

TREATMENT OF MENINGITIS and SEPTICEMIA IN INFANCY WITH A SULPHAMETHOXAZOLE/TRIMETHOPRIM COMBINATION

Abstract. Sabel, K.-G. and Brandberg, Å. (Department of Paediatrics and Department of Medical Microbiology, University of Göteborg, Sweden). Treatment of meningitis and septicemia in infancy with a sulphamethoxazole/trimethoprim combination. Acta Paediatr Scand, 64:25, 1975.–Ten infants, 8 days to 10 months old, with meningitis and/or septicemia were considered therapeutic failures after conventional antibiotic treatment (i.e. kanamycin, ampicillin and sulfonamides) and given sulphame-thoxazole and trimethoprim parenterally. Nine patients recovered, 8 of them rapidly, and one after prolonged treatment for 34 days when kanamycin was added to the combination. One infant improved but later died of complications not related to the treatment. High concentrations in serum and cerebrospinal fluid were achieved with a daily dose of 30–40 mg sulphamethoxazole and 6–8 mg trimethoprim per kg without signs of accumulation. No change in resistance of the bacteria isolated was seen. A hemolytic reaction, probably due to the propylene glycol in the solution, was seen in one case. Other possible side-effects in this age-group are discussed. The antibiotic combination used seems to be a good alternative in the therapy of bacterial meningitis of infants caused by gram-negative bacteria. However it should still not be given to icteric or very immature infants and probably not during the first week of life.     

Novel use of porcine urinary bladder matrix for pediatric pilonidal wound care: preliminary experience

Background

Extracellular matrix is used in various applications. We present our preliminary experience using a new device that consists of a porcine extracellular matrix with an epithelial basement membrane (MatriStem^®, ACell, Inc. Columbia, MD, USA) for adolescent pilonidal disease.

Methods

A retrospective review of four patients with pilonidal disease was undertaken. Three occurred in the gluteal cleft, and the fourth in the umbilicus. In the first patient, the wound deficit was filled with lyophilized MicroMatrix powder and a sheet of Multilayer Wound Matrix was placed to cover the wound. In the second patient, two sinus tracts were debrided, packed with MicroMatrix, and a sheet of fenestrated Burn Matrix was applied. In the third patient, MicroMatrix and Surgical Matrix PSMX (six-layer) was applied as a roll filling the dead space. In the last patient, an umbilical sinus 3 cm deep was packed with MicroMatrix powder followed by a rolled sheet of 2-ply Surgical Matrix RS. Patients were evaluated weekly post-operatively, and more MicroMatrix and sheet material was added if a wound deficit was still present. Measurements were taken in two dimensions, diameter and depth, to characterize wounds.

Results

Resolution of wound deficit was graphed versus time. Pain was assessed by scoring 0–10. Rapid wound closure was achieved. Two of the patients had failed wound healing with saline dressing changes prior to MatriStem application. These two patients in particular were highly satisfied with the comfort of the MatriStem approach relative to their time with saline dressings. Most had no pain after 1 week when bolster sutures were removed.

Conclusion

In the treatment of open pilonidal wounds in adolescents, porcine urinary bladder matrix wound care devices offer closure times and cost similar to well-established methods while offering a substantial advantage in terms of patient comfort and convenience. This preliminary experience supports a prospective study.

     

A population-based observational study of restrictive guidelines for antibiotic therapy in early-onset neonatal infections

BACKGROUND: The extensive use of broad-spectrum antibiotics has been associated with major changes in the spectrum of organisms involved in early-onset neonatal infection (EONI), their susceptibility to antibiotics, or both. Therefore, guidelines for a more rational use of antibiotics in neonates have been developed. We conducted a population-based observational study to assess the effectiveness and compliance with restrictive guidelines for the antibiotic therapy in EONI. METHODS: Neonates receiving antibiotics within 72 hours of life were identified prospectively by population-based surveillance in the 18 hospitals of Burgundy, between February 2002 and June 2003. They were treated in accordance with guidelines limiting the use of broad-spectrum antibiotics and shortening the treatment duration. Each neonate included was evaluated for 60 days after birth. An unfavorable outcome was defined as death related to EONI or late-onset infection. RESULTS: Of the 25,480 infants born during the study period, 1012 received antibiotics at birth. Of these 1012 infants, 39 were definitely infected (septicemia), 288 clinically infected and 685 not infected. The EONI cure rate was 96.8% without infectious relapse. Forty-five infants received a second course of antibiotic therapy. Birth weight (OR: 5.6; 95% CI: 2.2-14.1), mechanical ventilation (OR: 4.1; 95% CI: 1.3-13.1), central venous catheterization (OR: 16.1; 95% CI: 1.8-141.9), and antibiotic therapy duration (OR: 2.5; 95% CI: 1.1-5.5) were independently associated with late-onset infection. CONCLUSION: Reducing the antibiotic therapy duration does not increase the risk of infectious relapse and may decrease the incidence of late-onset infection.     

儿童严重创伤性软组织损伤的负压封闭治疗

目的 探讨负压封闭引流技术(vacuum sealing drainage,VSD)治疗儿童严重创伤性软组织损伤的效果.方法 16例严重创伤性软组织损伤的患儿,共20个创面,创面范围约为10 cm× 15 cm～30 cm×50 cm,严格清创后采用负压封闭引流(VSD)技术,持续40～60 kPa负压引流,5～7d后再行Ⅱ期缝合、植皮、组织瓣转移闭合创面.同期13例采用传统换药或引流的患儿为对照组.结果 VSD治疗组中,15例经负压封闭引流治疗后均可见创面肉芽组织新鲜.Ⅱ期缝合、植皮或组织瓣转移全部成活,无局部和全身并发症,1例反取皮原位移植的患儿发生创面感染,多次引流后行游离植皮成功.VSD治疗组与对照组比较,在Ⅱ期缝合时间、换药次数、平均住院时间及植皮愈合率等方面均有统计学意义(P<0.05)结论负压封闭引流技术能充分引流、控制感染和刺激创面肉芽组织生长,为及早覆盖创面提供了良好的条件,而且可以免除换药和缩短治愈时间,是治疗儿童严重创伤性软组织损伤的一种简便、有效方法.     

Honey and a mixture of honey, beeswax, and olive oil-propolis extract in treatment of chemotherapy-induced oral mucositis: a randomized controlled pilot study

In spite of being one of the most investigated subjects among supportive care in cancer, no therapy has been found effective in treatment of chemotherapy-induced oral mucositis. Based on the observations that honey bees products have anti-inflammatory and wound healing effects, the present study tried to evaluate the effect of topical application of honey and a mixture of honey, olive oil-propolis extract, and beeswax (HOPE) in treatment of oral mucositis. This was a randomized controlled clinical trial conducted on 90 patients with acute lymphoblastic leukemia and oral mucositis grades 2 and 3. The mean age of enrolled patients was 6.9 years. The patients were assigned into 3 equal treatment groups: Honey, HOPE, and control groups. Topical treatment for each patient consists of honey, HOPE, and benzocaine gel for honey, HOPE, and control groups, respectively. Recovery time in grade 2 mucositis was significantly reduced in the honey group as compared with either HOPE or controls (P < .05). In grade 3 mucositis, recovery time did not differ significantly between honey and HOPE (P = 0.61) but compared with controls, healing was faster with either honey or HOPE (P < .01). Generally, in both grades of mucositis, honey produced faster healing than either HOPE or controls (P < .05). Based on our results that showed that honey produced faster healing in patients with grade 2/3 chemotherapy-induced mucositis, we recommend using honey and possibly other bee products and olive oil in future therapeutic trials targeting chemotherapy-induced mucositis.     

早产儿早期经验性应用抗生素对其肠道菌群的近期影响

目的利用16S r DNA PCR及变性梯度凝胶电泳(DGGE)技术,探讨生后经验性应用抗生素对早产儿早期肠道菌群的影响。方法以2014年1月至2015年1月在重庆医科大学附属儿童医院住院治疗的早产儿为研究对象,使用哌拉西林-他唑巴坦7 d为哌拉西林组,7 d内未使用抗生素为对照组。收集胎粪(12 h)和3、5、7日龄(d3、d5、d7)的粪便标本,采用PCR-DGGE方法对肠道菌群的变化行动态观察,同时行克隆测序分析菌群组成的变化。结果 24例早产儿的96份粪便标本进入分析,哌拉西林组和对照组各12例,两组基线具可比性。24份胎粪提取细菌DNA后行PCR扩增失败,未行DGGE分析。1哌拉西林组d3、d5、d7时点的Shannon指数中位数(P25~P75)分别为1.64(1.16~1.92)、1.97(1.69~2.20)和1.22(0.69~2.10);对照组分别为1.39(0.94~1.94)、2.24(2.07~2.49)和2.38(2.07~2.61),哌拉西林组d7时点的Shannon指数显著低于对照组(P0.05)。2随日龄增加,对照组Shannon指数逐渐升高;哌拉西林组Shannon指数呈降低趋势。3d7时点哌拉西林组和对照组均以克雷伯菌属占绝对优势(35.5%和42.4%),且乳酸杆菌属检出率均较低(1.6%和0.8%)。哌拉西林组较对照组肠球菌属(21.0%vs 7.2%)及链球菌属(25.8%vs 4.0%)比例明显增加,肠杆菌比例明显降低(3.2%vs 12.8%)。结论早产儿菌群结构简单,生后抗生素应用会降低肠道菌群多样性。     

Subdural empyema complicating cerebrospinal fluid shunt infection.

Subdural empyema has not been reported previously as a complication of cerebrospinal fluid (CSF) shunt surgery. An infant submitted to CSF shunt insertion for congenital hydrocephalus developed subdural empyema after a failed attempt to treat a superficial scalp wound infection with oral antibiotics. Enterobacter cloacae was isolated from the empyema. Temporizing management of the preceding superficial wound infection with oral antibiotics probably was the cause of this exotic pathogen. The treatment of infected scalp wounds contiguous with shunt hardware must be surgical.     

Umbilical hernia repair in children: is pressure dressing necessary

The use of pressure dressing to cover the sutured surgical wound is usually considered a routine conclusion to the repair of umbilical hernias in children. The wound is usually left dressed for a minimum of 5–7 days. The main purpose of pressure dressing is prevention of a hematoma formation. The aim of this study was to compare the surgical outcome after umbilical hernia repair in children when the wounds were covered using pressure dressing or left exposed without dressing after the completion of wound closure. Ninety-six patients with umbilical hernia repair were prospectively randomized to receive pressure dressing (n = 52) or have their wounds left exposed without any dressing (n = 44) after the completion of wound closure. None of the hernias were huge umbilical hernia and none required an umbilicoplasty. In the group who received pressure dressing, one patient developed wound infection 1.9% while no patients developed wound infection in the group who had their wounds exposed without any dressing. In children, there was no significant difference in terms of wound infection, hematoma or seroma formation and recurrence rate after applying pressure dressing or leaving the surgical wounds exposed without any dressing after completion of wound closure. Pressure dressing after umbilical hernia repair may be unnecessary.     

Successful treatment of infective endocarditis with recombinant tissue plasminogen activator

OBJECTIVES: In a prospective study, we examined the effect of treatment with recombinant tissue plasminogen activator (r-TPA) on survival and morbidity in a series of high-risk children with infectious endocarditis (IE) after prolonged treatment with indwelling catheters. We hypothesized that r-TPA is an adjunctive therapy for dissolution of infected thrombi in drug-resistant IE. STUDY DESIGN: In the prospective 3-year study (1998-2001), we identified high-risk children with chronic illness and prolonged treatment with indwelling catheters who developed IE and overwhelming sepsis. Patients were allocated to receive r-TPA after persistent and enlarging intracardiac vegetations and failure to respond to conventional medical management. Complications associated with treatment, survival, and cardiac morbidity were observed. RESULTS: Seven infants were treated prospectively with r-TPA. All infants responded promptly to treatment, with resolution of the intracardiac vegetations within 3 to 4 days of commencement and without any adverse complications. All patients survived without long-term cardiac morbidity. CONCLUSION: Recombinant tissue plasminogen activator may offer a safe alternative to surgical intervention in the high-risk infant with IE.     

Treatment of chronic wounds by local delivery of granulocyte-macrophage colony-stimulating factor in patients with neutrophil dysfunction

Chronic wounds are associated with considerable morbidity and prolonged hospitalizations. The availability of recombinant growth factors and cytokines provides a new modality for treatment of recalcitrant wounds. Granulocyte-macrophage colony-stimulating factor (GM-CSF), a growth protein for hematopietic cells, also enhances neutrophil and monocyte function and promotes keratinocyte proliferation. In three patients with inherited disorders associated with leukocyte dysfunction and non-healing wounds, topical application of GM-CSF resulted in complete wound closure within 1 to 4 weeks. A subcutaneous (s.c.) infusion pump for the local s.c. delivery of GM-CSF was also found to enhance healing. Local application of GM-CSF may thus promote wound closure in patients with impaired wound healing.     

浸浴结合人工生物敷料和血小板胶治烧伤患儿后期残余创面的观察

目的 观察浸浴结合人工生物敷料和血小板胶治疗烧伤后期残余创面的效果.方法 将有烧伤后期残余创面的56例患儿分为实验组(28例)和对照组(28例).实验组患儿浸浴后,用血小板胶喷洒于创面,将生物敷料覆盖于创面行半暴露疗法,用血小板胶喷湿敷料2次/d,每2至3 d浸浴1次并更换敷料;对照组创面消毒后仅以单层碘伏纱布覆盖行半暴露疗法.1个疗程(10 d)结束后,比较二组患儿的治愈率、有效率、创面细菌学情况及相关安全性指标.结果 实验组和对照组患儿的治愈率、有效率、细菌清除率分别为64.3%、89.3%、92.3%和32.1%、67.9%、72.0%,二组上述指标比较,差异均有统计学意义(P<0.01).二组患儿未发生不良反应.结论 浸浴结合应用新型人工生物敷料和血小板胶治疗烧伤患儿后期残余创面安全、有效,可控制创面感染、提高治愈率.     

肺泡毛细血管发育不良一例报告并文献复习

目的 报道1例肺泡毛细血管发育不良(alveolar capillary dysplasia,ACD),并复习文献20例.方法 自Medline检索国外报道病例.结果 本例为足月顺产,生后5 h开始出现呼吸窘迫,给予呼吸机辅助呼吸等无效,生后第4天死亡,尸检病理学诊断符合肺泡毛细血管发育不良.21例中,19例足月儿,2例早产儿.19例出生体重正常,男∶女=7∶14.15例出生Apgar评分正常;16例在出生24 h内出现缺氧症状,5例在生后1～19 d内起病;20例出现肺动脉高压,全部患儿出现心脏血液右向左分流.20例给予呼吸机辅助呼吸;7例行高频振荡通气;12例行体外膜肺支持;14例行一氧化氮吸入治疗,4例行肺表面活性物质治疗.6例行肺部活检.胸部X线检查显示,3例表现正常,9例出现气胸,7例出现双肺网状影、颗粒状影以及弥漫性斑片状影、透过度减低等,2例肺血管影减少.全部21例均死亡,其中8例在出生10 d内死亡,7例在出生30 d内死亡,最长存活时间为4个月.14例伴有先天性心血管系统、消化系统、泌尿系统、呼吸系统等畸形,其中1例伴发染色体畸形,2例有家族遗传倾向.结论 目前,本病尚无特效治疗、且预后不良、医疗费用巨大.当新生儿出现呼吸衰竭或者PPHN,常规治疗无效时,应该高度怀疑此病,并行常规开放式肺组织活检,以明确诊断.