Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus

Bromelain; Burn wound; Enzymatic debridementBromelina; Herida por quemadura; Desbridamiento enzimáticoBromelina; Ferida per cremada; Desbridament enzimàticBackground Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193–202, 2017), on the use of enzymatic debridement with NexoBrid® in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists. Methods A consensus guideline was established by following a modified Delphi methodology of a 38-topic survey in two rounds of participation. Items were grouped in six domains: general indication, indication in critical patients, pain management, conditions for NexoBrid® application, NexoBrid® application technique, and post-debridement wound care. Results In the first round, experts established consensus (strongly agree or agree) on 13 of the 38 statements. After the second round, a consensus was reached on 24 of the 25 remaining statements (97.2%). Conclusions The present updated consensus document provides recommendations on the use of bromelain-based enzymatic debridement NexoBrid®, integrating the extensive clinical experience of plastic surgeons, intensivists, and anesthesiologists in Spain. Further clinical trials and studies are required to corroborate, modify, or fine tune the current statements

Barriers and facilitators of physical activity in adults with severe haemophilia: A qualitative study

Background: People with haemophilia (PWH) tend to be less physically active than the general population, but there is a lack of research on the specific barriers and facilitators affecting their participation in physical activities. Objectives: This study aims to explore perceived barriers and facilitators to physical activity in severe PWH. Design: An explorative qualitative study based on focus groups. Methods: Four focus groups including 16 participants (severe haemophilia A patients) were conducted to examine the factors perceived as facilitators or barriers to haemophiliacs engaging in physical activity. One researcher conducted a thematic analysis of all data. Results: Three themes were identified: body function, personal factors, and environmental factors. Key facilitators identified were access to prophylaxis treatment to reduce the risk of bleeding(s), the enjoyability of physical activity, fitness and health motives, social interaction, support, and low cost. PWH faced additional barriers to being physically active including hurtful joints, mobility issues, haemophilic arthropathy, dislike or disinterest, lack of motivation, fear of injury, tiredness, lack of time, lack of guidance, negative social influence, restriction, and lack of coordination of prophylaxis treatment. Conclusion: This exploratory study demonstrated that participation in physical activity in PWH is influenced not only by their own abilities and attitudes, but also by external variables, including family, friends, healthcare professionals, structures, and communities. The results of this study may be used to assist caregivers and health professionals, inform programs, interventions, and policies to promote physical activity and health in severe PWH

Identification of genes which are associated with production diseases in pigs and chickens

Production disease in pigs and chickens is caused by a variety of different pathogens, mainly enteric and respiratory, which may result in significant economic losses. Other factors such as stress, poor husbandry and nutrition can also contribute to an animal’s susceptibility to disease. Molecular biomarkers of production disease could be of value by improving diagnosis and risk analysis to determine best practice with an impact on increased economic output and animal welfare. Over 480 chicken tissue samples from countries including Belgium, Spain and the UK, and over 115 pig samples from Belgium, Spain, France and Ireland were available. Samples included lung, intestine, mesenteric and tracheobronchic lymph node, bone, cartilage and sciatic nerve. Two types of software were used to analyse the microarray data; Genespring was used for statistical analysis and visualisation of transcriptomic data and Cytoscape was used to visualise molecular interaction networks between genes. Results indicated that panels of genes may identify a broad spectrum of infectious disease in chickens, whereas combinations of upregulated genes may be used as biomarkers of specific pathogens such as Escherichia coli or Eimeria. Pigs from two lines (RFI high and low) were kept in dirty environments which had the same bedding and clean environments which had fresh bedding. A greater difference was observed in the number of genes differentially expressed in the RFI high pigs than RFI low pigs. Pathway analysis from both chicken and pig experiments indicated that many networks were affected including those involved in regulating the immune-system. Whilst a large number of studies have been carried out in human medicine, further work is needed to identify molecular biomarkers in veterinary medicine and in particular those associated with production disease in the pig and poultry livestock industry

Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus.

Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193-202, 2017), on the use of enzymatic debridement with NexoBrid® in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists. A consensus guideline was established by following a modified Delphi methodology of a 38-topic survey in two rounds of participation. Items were grouped in six domains: general indication, indication in critical patients, pain management, conditions for NexoBrid® application, NexoBrid® application technique, and post-debridement wound care. In the first round, experts established consensus (strongly agree or agree) on 13 of the 38 statements. After the second round, a consensus was reached on 24 of the 25 remaining statements (97.2%). The present updated consensus document provides recommendations on the use of bromelain-based enzymatic debridement NexoBrid®, integrating the extensive clinical experience of plastic surgeons, intensivists, and anesthesiologists in Spain. Further clinical trials and studies are required to corroborate, modify, or fine tune the current statements