This study aims to investigate the effect of different energy densities provided by low-level laser therapy (LLLT) on the morphology of scar tissue and the oxidative response in the healing of secondary intention skin wounds in rats. Twenty-four male adult Wistar rats were used. Skin wounds were made on the backs of the animals, which were randomized into three groups of eight animals each as follows, 0.9% saline (control); laser GaAsAl 30 J/cm(2) (L30); laser GaAsAl 90 J/cm(2) (L90). The experiment lasted 21 days. Every 7 days, the wound contraction index (WCI) was calculated and tissue from different wounds was removed to assess the proportion of cells and blood vessels, collagen maturation index (CMI), thiobarbituric acid reactive substance (TBARS) levels and catalase activity (CAT). On the 7th and 14th days, the WCI and the proportion of cells were significantly higher in groups L30 and L90 compared to the control (p < 0.05). At all the time points analyzed, there was a greater proportion of blood vessels and a higher CMI in group L90 compared to the other groups (p < 0.05). On the 7th and 14th days, lower TBARS levels and increased CAT activity were found in the L90 group compared to the control (p < 0.05). On the 7th day, a moderately negative correlation was found between TBARS levels and WCI, CMI and CAT in all the groups. LLLT may modulate the oxidative status of wounded tissue, constituting a possible mechanism through which the LLLT exerts its effects in the initial phases of tissue repair.

Background The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. Objective The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. Methods This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. Results The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. Conclusions In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. Trial Registration PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137

Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.Abbreviations: ACE2 = angiotensin-converting enzyme 2, AP = alternative complement pathway, ARDS = acute respiratory distress syndrome, C4d = complement component 4d, C5b-9 = complement membrane attack complex, CoVs = coronaviruses, ECM = extracellular matrix, eNOS = endothelial nitric oxide sintetase, ICU = intensive care unit, IL-1 = interleukin-1, IL-10 = interleukin-10, IL-1alpha = interleukin-1alpha, IL-1beta = interleukin-1beta, IL-6 = interleukin-6, LP = lectin complement pathway, MASP-2 = mannose-binding protein-associated serine protease 2, MBL = mannose-binding lectin, NOX2 = NADPH oxidase 2, PAI-1 = plasminogen activator inhibitor 1, PI = pressure injury, PubMed = Public Medline, RAAS = renin-angiotensin-aldosterone system, SARS-CoV = severe acute respiratory syndrome-related coronavirus, SciELO = Scientific Electronic Library Online, TNF-alpha = alpha tumor necrosis factor.

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Introduction: Pressure injury is 1 of the most common pressure related injuries in patients admitted to the intensive care unit. In individuals with darker skin tones, skin assessment protocols appear to be less effective, resulting in early damage from pressure. Bedside assessment measures using ultrasound and infrared thermography (IRT) have been studied to identify pressure injuries. Patient concerns: A 58-year-old dark-skinned male was admitted to the intensive care unit due to an ischemic stroke. Diagnosis: The visual evaluation of the skin took place on the second day after admission to the intensive care unit (before 48 hours). The patient had a whitish erythema on the left heel (LH) and a large bloody blister on the right heel. There were no signs of color change on the sacrum skin. Interventions: We performed 3 skin evaluations of the sacrum and calcaneus using ultrasound and IRT. Outcomes: Changes in the temperature of the target regions (sacrum, right heel and LH) were observed. The right heel showed higher mean temperatures than the LH in all evaluations. In the first evaluation of the sacrum region, the average temperature was lower (-1.3°C) than in the second and third evaluation (1°C). In the calcaneus, the mean temperature range (right heel - LH) showed a difference of (3.5°C) in the first evaluation, a difference of (1.4°C) in the second evaluation, and a difference of (1.7°C) in the third evaluation. Ultrasound images of the selected regions showed abnormal tissue patterns - edema - since the first evaluation. Conclusion: These findings indicate that the regions with deep tissue injury on ultrasound evaluation were compatible with the regions of abnormal temperatures in the IRT. IRT could identify regions of pathological process, which could be confirmed by abnormal ultrasound findings. Well-designed, randomized research with a larger sample could verify if the combination of these assessment techniques could be used as a potential method for early detection and evaluation of pressure injuries.

Photodynamic therapy today is becoming an important role in the healing of lacerated tissues, since it has therapeutic resources capable of accelerating this process. One treatment option is the clinical phototherapy, and Photodynamic Therapy (PDT) is being widely used. This study aims to evaluate the effect of PDT on the healing of skin wounds in rats. We used a sample of 39 male rats Wistar divided into three groups, a control, a PDT-treated green and red with the last PDT. After 24 hours before the surgical incisions, PDT was used in both groups for 6 minutes and was evaluated in histological level, the inflammatory reaction and the repair process. The results showed that the granulation tissue was more developed in the irradiated group than in the control group and the amount of chronic inflammatory cells (monocytes, macrophages, lymphocytes and plasma cells) predominated with green phototherapy. The epithelialization in the wound margins and scarring with better quality occurred with red PDT (640 nm), which the higher deposition was of collagen. However, phototherapy not collimated of 640 nm (red) resulted in better anti-inflammatory effects. Given these answers with phototherapy not collimated green (525 nm) and red (640 nm), we conclude that the use of these

This paper aims to compare the therapeutic effect of the laser As-Ga of 904nm and pulsed Ultrasound of 1 MHz applied in striated skeletal muscle of inflamed rats. The animals received an intramuscular injection of bupivacaine hydrochloride in tibialis muscle in order to induce the inflammatory process, and after 24 hours, the time was considered 0 for the initiation of therapy, using a laser and ultrasound. Samples collected the muscles of the animals were stained with Hematoxylin-Eosin and histological sections of the groups used for the analysis of the muscle tissue in relation to reducing the inflammatory process, comparing the results of the two therapies used. In this study it is suggested that both treatment with laser as with ultrasound can act as anti-inflammatory. However, the laser seems to have anti-inflammatory effect for all periods observed, while the ultrasound was only able to induce declining inflammatory response to seven days.
O presente trabalho tem como objetivo comparar o efeito terapêutico do Laser As-Ga de 904nm e do Ultra-som pulsado de 1 MHz aplicado em músculo estriado esquelético inflamado de ratos Wistar. Os animais receberam uma injeção intramuscular de cloridrato de bupivacaína no músculo tibial, a fim de induzir o processo inflamatório, e após 24 horas, foi considerado o tempo 0 para o início da terapia, utilizando-se o laser e o ultra-som. As amostras coletadas dos músculos dos 35 animais foram coradas com Hematoxilina-Eosina e as secções histológicas dos grupos serviram para as análises do tecido muscular em relação à redução do processo inflamatório, comparando os resultados das duas terapias utilizadas. Neste trabalho sugere-se que tanto os tratamentos com laser quanto com ultra-som podem agir como antiinflamatórios, no entanto, o laser parece ter efeito antiinflamatório durante todos os períodos observados, enquanto o ultra-som somente foi capaz de induzir diminuição da resposta inflamatória aos sete dias

Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4