Abstract: The authors report the antibiotic susceptibility of 200 non-duplicate Staphylococcus aureus isolates from clinical samples and characterization of methicillin-resistant S aureus (MRSA) in Southwestern Nigeria. All the isolates were susceptible to teicoplanin, vancomycin, fusidic acid, and rifampicin, and less than 3% were resistant to erythromycin, clindamycin, neomycin, and minocycline. The high rates of methicillin-sensitive S aureus (MSSA) resistance to sulfonamides and tetracycline could be attributed to widespread use of these antibacterial agents in Nigeria. Only 3 isolates were confirmed as MRSA based on the detection of the mecA gene. Clonal relatedness of 1 MRSA strain in Southwestern Nigeria with epidemic MRSA-15 was confirmed by pulsed field gel electrophoresis. The identification of multi-resistant MSSA and 1 high-level mupirocin-resistant S aureus indicates that strict antibiotic and infection control policies are important factors to be considered in health inst

Abstract: In response to the need for a dressing technique that interrupts the causal pathway of trauma in the healing of chronic diabetic neuropathic forefoot ulcerations, the authors devised a dressing with supplies that are widely available, inexpensive, and reliably applied with little additional training. A prospective analysis of the proposed “football” dressing is presented. Results are compared to literature employing total contact casting and instant total contact casting. Fifteen subjects are included. A t test was used to evaluate the role of infection in the wounds. Infection in the wound was not found to be a statistically significant factor in healing with the football dressing (P = 0.2). Total weeks for complete epithelization of forefoot ulcers was 3.80 ± 2.60 (range 1–10 weeks). Healing rates comparable to total contact casting are noted with the football dressing on these forefoot wounds. This fact coupled with the low cost and ease of application make this dressing t

Abstract: The tsunami of December 26, 2004, had an enormous death toll, and during the aftermath, numerous victims developed severe wound infections. The initial stream of victims was tremendous and had to be managed under extraordinary circumstances, often with too few staff, surgical equipment, and antibiotics, which posed challenges to the treatment of wounds. Wounds were often empirically treated with antibiotics without the support of culture results. The medical literature, Internet, and lay press carried reports of patients being at risk of deadly fungal infections and infections caused by waterborne and highly resistant pathogens. In most cases, these reports concerned only 1 or 2 repatriated travelers. The authors analyzed wound infections, culture results, and resistance patterns seen in 23 repatriated tsunami victims. Wound cultures showed a spectrum of pathogens different from those usually encountered in European hospitals. A combination of waterborne bacteria and a high p

Abstract: The objective of this study was to clinically evaluate the amino acid homocysteine (Hcy) as a risk factor for impaired wound healing in 12 patients receiving topical human fibroblast-derived dermal substitute treatment for nonhealing lower-extremity wounds. Homocysteine is a significant risk factor for atherosclerotic vascular disease and is an inhibitor of nitric oxide (NO) bioactivity. The data from this preliminary study documented a correlation between elevated serum Hcy, significantly (P < 0.05) decreased wound NO bioactivity by measurement of wound fluid nitrate and nitrite (NOx, the stable oxidation products of NO), and impaired wound healing. In a single case report, successful treatment of elevated Hcy was documented to restore normal wound healing. In the authors’ wound center, untreated, elevated Hcy was observed in 50% of patients with chronic, nonhealing wounds, 63% of patients with diabetic, neuropathic ulcers, and 47% of patients without diabetes with chronic,