Bestian Medical Center

We aimed to investigate how the thickness of removed skin grafts affects the healing time at the donor site, with a focus on the depth of the donor wound and the normal thickness of the scalp. We examined the outcomes of the donor sites of thick split-thickness skin grafts using hairy scalp skin in 102 Korean patients. We measured the thickness of the scalp donor skin using preoperative ultrasonography, histometric thickness of normal scalp skin in 61 patients, and histometric thickness of the thickest part of the grafted skin after surgery. The mean normal ultrasound thickness of the scalp donors was 1.711 mm, with a mean histometric normal scalp thickness of 1.926 mm (61 cases), mean dermatome depth set of 0.569 mm (22/1000 inches, 22 mils), and mean histometric harvested skin thickness of 0.677 mm. The relationship between healing time and percentage of histometric graft thickness per ultrasonographic normal scalp skin thickness was statistically significant and correlated positively. Healing of the partial portion of the scalp was delayed in 9 donors due to infection and folliculitis. Scalp donor wounds healed during postoperative days 6 and 15, except for the ones with infected portions. Patients in this study successfully achieved scarless regenerative healing of their scalp donor wounds. Furthermore, adequate wound dressing can prevent alopecia and scarring of infected donor wounds. The results of this study offer valuable insights into the advantages of using scalp skin in grafts, underscoring its potential as a preferred option for achieving optimal regenerative healing.

The primary objective of this study was to investigate the factors contributing to hyperglycemic adverse events (AEs) associated with the administration of remdesivir in hospitalized patients diagnosed with coronavirus disease 2019 (COVID‐19). Furthermore, the study aimed to develop a risk score model employing various machine learning approaches. A total of 1262 patients were enrolled in this investigation. The relationship between covariates and hyperglycemic AEs was assessed through logistic regression analysis. Diverse machine learning algorithms were employed for the purpose of forecasting hyperglycemia‐related complications. After adjusting for covariates, individuals with a body mass index ≥23 kg/m2, those using proton pump inhibitors, cholinergic medications, or individuals with cardiovascular diseases exhibited approximately 2.41‐, 2.73‐, 2.65‐, and 1.97‐fold higher risks of experiencing hyperglycemic AEs (95% CI 1.271–4.577, 1.223–6.081, 1.168–5.989, and 1.119–3.472, respectively). Multivariate logistic regression, elastic net, and random forest models displayed area under the receiver operating characteristic curve values of 0.65, 0.66, and 0.60, respectively (95% CI 0.572–0.719, 0.640–0.671, and 0.583–0.611, respectively). This study comprehensively explored factors associated with hyperglycemic complications arising from remdesivir administration and, concurrently, leveraged a range of machine learning methodologies to construct a risk scoring model, thereby facilitating the tailoring of individualized remdesivir treatment regimens for patients with COVID‐19.

Abstract IntroductionWith the global spread of Coronavirus disease (COVID-19) and public health crisis, appropriate allocation of healthcare human resources has been necessitated. Although nursing practice takes up a larger part of medical practice in hospitals, the quantitative assessment of nursing care has not been investigated for human resource allocation in the medical field. The objective of this study to explore the time spent for each nursing intervention, and compared provided amount of nursing intervention between negative pressure isolation wards (NPIWs) and general wards (GWs) provided by COVID-19 hub hospitals.MethodsThis research is a time-motion (TM) observational study. Three trained external observers recorded their observations for every minute in 19 different work schedules in 2 NPIWs and 2 general respiratory wards. Observation items were chosen based on the standard operating guidelines of Integrated Nursing and Caring Services developed by the Ministry of Health and Welfare and National Health Insurance Service. The average nursing workload per shift was compared by calculating the sum of the spent time of three nurses staffed in each shift in each ward between two groups. In addition, to compare the amount of directed nursing care for patients between two types of wards, nursing work category was divided into directed and undirected nursing interventions.ResultsIn the comparison of demographic characteristics of nursing workforce between two groups, there was no statistically significant difference (p>0.05 respectively). In both groups, the most time-consuming nursing work category was recording in three work shifts. The average duration of those work tasks was 312.5 minutes in NPIWs and 307 minutes (per 3 nurses) in GWs, having no significant difference (p>0.05). Of all nurse duties, the second most time-consuming work category was others (including changing to protective clothing) in NPIWs, and medication administration and transfusion in GWs. The mean duration of performing the category for others that include wearing PPE was 308 minutes in NPIWs and 160 minutes (per 3 nurses) in GWs, showing a significant difference (p<0.05). The greater amount of time was taken for hygiene management in isolation wards. Medication administration and transfusion and nursing assessment were more frequently performed in GWs, demonstrating a statistical significance. In the aggregated spent time for all duties including directed and undirected nursing care, the time spent for directed nursing care was 654 minutes longer in GWs than in NPIWs (per 3 nurses) in each work shift, displaying a significant difference.ConclusionThis study provides the quantitative difference in time-consuming nursing works between NPIWs and GWs by direct observation. Recording was the most time-consuming nursing work category in both NPIWs and GWs. Considering nurses in each duty in GWs provided more directed nursing care than nurse in NIPWs, careful considerations are required in allocation of nursing workforce.

Congenital hypoplasia of the depressor anguli oris muscle is a rare cause of asymmetrical crying facies in newborns. The clinical manifestations range from mild to severe asymmetry and may persist up to adulthood. In the current case, the patient did not exhibit other congenital anomalies or paralysis of other branches of the facial nerve. This adult patient presented with severe asymmetrical lower lip deformity during full mouth opening since birth. A chromosomal study for the detection of 22q gene deletion yielded negative results. The electromyography findings of the lower lip were insignificant. Depressor labii inferioris muscle resection was not effective, but bidirectional (horizontal and vertical) fascia lata grafting improved the aesthetic appearance of the asymmetrical lower lip. The patient showed improved lower lip symmetry during full mouth opening at 1 year after the surgery. Therefore, the details of this rare case are reported herein.

Autologous skin cell suspensions have been used for wound healing in patients with burns and against normal pigmentation in vitiligo. To separate cells and the extracellular matrix from skin tissue, most researchers use enzymatic digestion. Therefore, this process is difficult to perform during a routine surgical procedure. We aimed to prepare a suspension of noncultured autologous skin cells (NCSCs) using a tissue homogenizer as a new method instead of harsh biochemical reagents. The potential clinical applicability of NCSCs was analyzed using a nude-rat model of burn healing. After optimization of the homogenizer settings, cell viability ranged from 52 to 89%. Scanning electron microscopy showed evidence of keratinocyte-like cell morphology, and several growth factors, including epidermal growth factor and basic fibroblast growth factor, were present in the NCSCs. The rat model revealed that NCSCs accelerated skin regeneration. NCSCs could be generated using a tissue homogenizer for enhancement of wound healing in vivo. In the NCSC group of wounds, on day 7 of epithelialization, granulation was observed, whereas on day 14, there was a significant increase in skin adnexa regeneration as compared to the control group (PBS treatment; p<0.05). This study suggests that the proposed process is rapid and does not require the use of biochemical agents. Thus, we recommend a combination of surgical treatment with the new therapy for a burn as an effective method.

Severe paroxysmal sympathetic overactivity occurs in a subgroup of patients with acquired brain injuries including traumatic brain injury, hypoxia, infection and tumor-related complications. This condition is characterized by sudden increase of heart rate, respiratory rate, blood pressure, body temperature and excessive diaphoresis. The episodes may be induced by external stimulation or may occur spontaneously. Frequent occurrence of this condition could result in secondary morbidities, therefore, should be diagnosed and managed insightfully. These symptoms could be confused with seizures or other medical conditions, leading to unnecessary treatment. Despite clinical significance of paroxysmal sympathetic hyperactivity (PSH), brain tumor-induced PSH has not been studied nearly. In this report, two cases of the PSH in patients with brainstem-compressing benign tumors were introduced. The most useful pharmacologic agents were opioid (e.g., fentanyl patch) in preventing PSH attack, and nonselective β-blocker (e.g., propranolol) in relieving the symptoms. Clinical experiences of the rare cases of benign tumor-induced PSH can be helpful as an essential basis for further research.

Pediatric palmar hand burns are a difficult problem because of the serious hand deformity, with functional impairment resulting from rapid growth. In cases of severe pediatric palmar hand burns, a secondary full-thickness skin graft after a primary full-thickness skin graft offers a reliable way of obtaining the required functional and aesthetic outcomes.This study retrospectively evaluated 28 children who required palmar crease releases and secondary full-thickness skin grafts during the past 12 years. The case records were reviewed for sex and age distributions, injury mechanism, and time interval between the primary and secondary full-thickness skin grafts. Surgical procedures included secondary full-thickness skin grafts and incisional releases of grafted skin on the involved creases. There were 19 men and 9 women. The mean age at the time of the burn injury was 10.1 months (range, 5-19 months). The mean age at the time of the secondary full-thickness skin graft was 8.3 years (range, 3-17 years). The most common mechanism of burn injury was steam (n = 24). The median time interval from the primary to the secondary full-thickness skin graft was 67 months (range, 8-156 months). The number of released creases was 81. The number of palmar web contractures in 23 patients was 52. A secondary full-thickness skin graft was more frequently necessary in patients with a primary full-thickness skin graft in the proximal digital crease and palmar web areas. All patients achieved adequate digital length and palmar web contour after surgery. Our patients should be observed until the rapid pubertal growth period.