Acute and critical care for rabies bitten patients and the different outcomes in a Family: A Post Exposure Prophylaxis (PEP) Failure report

Rabies is a zoonotic viral disease that spread via infected animal saliva. Rabies virus belongs to Lyssavirus genus (Rhabdoviridae family) and the disease is endemic in Iran. The disease causes a fatal encephalomyelitis by infecting the nervous system. Dogs are the most common source of human rabies cases. In this presentation, we had a 58-year-old man who had a dog bitten history on his face and hands with his other two family members with the same dog at the same time. They received post-exposure prophylaxis (PEP) as soon as possible (from day 0). Eighteen days after bitten the man hospitalized and died of rabies three days after hospitalization. Other two relatives were healthy without any rabies symptom. The man was an Iranian veteran with residual body insults during the attacks of chemical warfare from the combat front. Obtained data in this study suggested that the direct inoculation of the virus to the nerve and immune system inability in virus clearing system were possible etiologies of PEP failure in the reported case. Keywords: Rabies Virus, Immunoglobulin, Pre-Exposure Prophylaxis (PrEP), Immunosuppressio

مقایسه روش بخیه با چسب مايع بافتی در ترميم زخم های صورت اطفال؛ یک مطالعه مورد شاهدی

Introduction: An ideal method for wound closure is one that is rapid, easy, safe, inexpensive, and pain-free with minimal infection and most importantly has minimum effect on the cosmetic issues. Therefore, this study was designed with the aim of evaluating the outcome of wound repair with liquid tissue adhesive agent and suture in pediatric traumatic wound repair. Methods: In this case-control study, 1 to 14 year-old children admitted to emergency department following traumatic injuries in need of wound closure via either suture or liquid tissue adhesive, were compared regarding speed of performance, rate of satisfaction in patient and the parents, rate of inflammation, pain and rate of wound closure on the 4th day as well as beauty results in the 6th month after wound repair. Data were analyzed via SPSS 20 and p<0.05 was considered as significance level. Results: 100 children with the mean age of 7.84 ± 3.33 years were evaluated (61% male). The 2 study groups were in the same condition regarding age, sex, and wound location; however, they were significantly different regarding wound shape (p < 0.0001), length (p = 0.037) and depth (p < 0.0001). Patient satisfaction (p < 0.0001) and parent satisfaction (p = 0.017) in addition to rate of procedure performance (p < 0.0001) were higher in cases of using adhesive. Regarding 6-month beauty outcome no significant difference was detected between the 2 groups (p = 0.463). Meanwhile, inflammation, pain and wound closure on the 4th day after repair was in better condition in the adhesive group. The results of sub-group analysis of the 2 study groups based on depth showed that the difference between the groups regarding pain (p = 0.756) and inflammation (p = 0.422) on the 4th day was not significant in cases with low depth (2-4 mm). Based on multivariate analysis, the only independent factor affecting better 4-day outcome of the patients was wound depth (p = 0.004) and in this model, closure type was removed from the final model. Conclusion: Based on the results of the present study, liquid tissue adhesive was superior to suture regarding speed of repair performance and satisfaction of the patients and the parents. Liquid tissue adhesive was accompanied by less inflammation and pain and higher probability of complete wound closure on the 4th day after repair. Regarding beauty, no significant difference was seen between the 2 mentioned methods. مقدمه: روشی برای بستن زخم ایده آل است که سریع، راحت، ایمن، ارزان، بی درد با حداقل عفونت و از همه مهمتر کمترین تاثیر در زیبایی بیمار باشد. لذا این مطالعه با هدف بررسی پیامد ترمیم با دو روش چسب مایع بافتی و بخیه در زخم های تروماتیک اطفال طراحی شد. روش کار: : در این مطالعه مورد شاهدی، اطفال یک تا چهارده ساله پذیرش شده در بخش اورژانس به دنبال زخم های تروماتیک نیازمند ترمیم با یکی از دو روش بخیه یا چسب مايع بافتی، مورد مقایسه از جهت سرعت انجام کار، میزان رضایتمندی بیمار و والدین، میزان التهاب، درد و میزان بسته شدن زخم در روز چهارم و همچنین نتایج زیبایی در ماه ششم بعد از ترمیم زخم قرار گرفتند. داده ها توسط نرم افزار آماری SPSS 20  تجزیه و تحلیل شدند و 05/0>p  به عنوان سطح معنی داری در نظر گرفته شد. يافته ها: 100  کودک با میانگین سنی 33/3 ± 84/7 سال مورد بررسی قرار گرفتند (61 درصد پسر). دوگروه مورد بررسی از نظر سن، جنس و محل زخم در شرایط یکسانی قرار داشتند اما از جهت شکل زخم (0001/0 > p)، طول زخم (037/0 = p) و عمق زخم (0001/0 > p) با یکدیگر اختلاف معنی داری داشتند. میزان رضایتمندی بیمار (0001/0 > p) و والدین (017/0 = p) و همچنین سرعت انجام پروسیجر (0001/0 > p) در موارد استفاده از چسب بالاتر بود. از جهت پیامد شش ماهه مرتبط با زیبایی بین دو گروه تفاوت معنی داری دیده نشد (463/0 = p). این در حالی است که میزان التهاب، درد و میزان بسته شدن زخم در روز چهارم بعد از ترمیم در گروه چسب از شرایط بهتری برخوردار بود. نتایج آنالیز زیر گروهی دو گروه مورد مطالعه بر اساس عمق نشان داد که اختلاف بین دو گروه از جهت درد (756/0 = p) و التهاب (422/0 = p) روز چهارم در موارد با عمق پایین (2 تا 4 میلی متر) معنی دار نبود. بر اساس آنالیز چند متغیره تنها فاکتور موثر مستقل در پیامد بهتر چهار روزه بیماران عمق زخم (004/0 = p) بود و در این مدل نوع ترمیم از مدل نهایی حذف گردید. نتيجه گيری: بر اساس نتایج مطالعه حاضر، چسب مایع بافتی از نظر سرعت انجام ترمیم و رضایتمندی بیمار و والدین نسبت به سوچور برتری داشت. چسب مایع با درد و التهاب کمتر و احتمال بالاتر بسته شدن کامل زخم در روز چهارم بعد از ترمیم همراه بود. از جهت زیبایی بین دو روش مذکور در شش ماه پس از ترمیم تفاوت معناداری دیده نشد

Comparison of Liquid Tissue Adhesive and Suture in Pediatric Wound Repair; a Case Control study

Introduction: An ideal method for wound closure is one that is rapid, easy, safe, inexpensive, and pain-free with minimal infection and most importantly has minimum effect on the cosmetic issues. Therefore, this study was designed with the aim of evaluating the outcome of wound repair with liquid tissue adhesive agent and suture in pediatric traumatic wound repair. Methods: In this case-control study, 1 to 14 year-old children admitted to emergency department following traumatic injuries in need of wound closure via either suture or liquid tissue adhesive, were compared regarding speed of performance, rate of satisfaction in patient and the parents, rate of inflammation, pain and rate of wound closure on the 4th day as well as beauty results in the 6th month after wound repair. Data were analyzed via SPSS 20 and p<0.05 was considered as significance level. Results: 100 children with the mean age of 7.84 ± 3.33 years were evaluated (61% male). The 2 study groups were in the same condition regarding age, sex, and wound location; however, they were significantly different regarding wound shape (p < 0.0001), length (p = 0.037) and depth (p < 0.0001). Patient satisfaction (p < 0.0001) and parent satisfaction (p = 0.017) in addition to rate of procedure performance (p < 0.0001) were higher in cases of using adhesive. Regarding 6-month beauty outcome no significant difference was detected between the 2 groups (p = 0.463). Meanwhile, inflammation, pain and wound closure on the 4th day after repair was in better condition in the adhesive group. The results of sub-group analysis of the 2 study groups based on depth showed that the difference between the groups regarding pain (p = 0.756) and inflammation (p = 0.422) on the 4th day was not significant in cases with low depth (2-4 mm). Based on multivariate analysis, the only independent factor affecting better 4-day outcome of the patients was wound depth (p = 0.004) and in this model, closure type was removed from the final model. Conclusion: Based on the results of the present study, liquid tissue adhesive was superior to suture regarding speed of repair performance and satisfaction of the patients and the parents. Liquid tissue adhesive was accompanied by less inflammation and pain and higher probability of complete wound closure on the 4th day after repair. Regarding beauty, no significant difference was seen between the 2 mentioned methods