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Upper extremities are frequently involved in fire burns due to the natural protective reflexes. The presence of bilateral Dupuytrenʼs disease and COVID-19 disease in patients with circumferential upper extremity burns can negatively impact the outcome, through severe contracture and a tendency to hypoxia or infections, which affects normal wound healing. Enzymatic debridement with a concentrate of proteolytic enzymes enriched in bromelain prevents compartment syndrome development in such patients, reduces blood loss, surgery duration, and appears to favor a more rapid recovery. [ABSTRACT FROM AUTHOR]

The presence of inhalation injury has a negative impact on the evolution of burned patients, being associated with increased mortality. It occurs as a direct consequence of thermal action, or secondary to the presence of respiratory irritants or absorption of toxins, and actual therapeutic management is mainly supportive. Several clinical findings are relevant to raising suspicion and guiding further examinations, fiberoptic bronchoscopy being the gold standard of diagnosis and staging. In burned patients with inhalation injuries, various reports showed that nebulized heparin (5,000 or 10,000 units) with a 4-hour administration regimen leads to improved outcome, reduces the days of mechanical ventilation and consequently the length of hospital stay, reduces pulmonary complications and improves lung function, having a safe profile, with fewer side effects. [ABSTRACT FROM AUTHOR]

Alcohol abuse is one of the leading health problems, with subsequent alcohol withdrawal syndrome (AWS) affecting around 50% of hospitalized patients, varying from mild to severe forms. Rapid recognition of AWS symptoms, along with prompt therapeutic management in the first 24 hours, can lead to better outcome. Improper treatment is correlated with seizure or delirium tremens, requiring specific intensive care management, and being the cause of with various complications, high mortality, and increased costs. Some studies reported possible predictive factors that may help clinicians identify patients at risk of developing severe or resistant forms. [ABSTRACT FROM AUTHOR]

Hospitalized COVID-19 patients often develop acute kidney injury (AKI), leading to increased mortality. In order to improve patients’ survival rate, it is important to understand the pathophysiology mechanism of AKI. In this brief review, we highlight the most important elements of the etiology and pathophysiology of COVID-19 associated AKI. Acute tubular injury seems to be more frequent than prerenal azotemia in COVID-19 patients and collapsing glomerulopathy is the most encountered form of glomerular disease. Another important role in acute kidney injury seems to play immune cell infiltration, inflammation, endothelial injury and microvascular thrombi. Renin-angiotensin-aldosterone system is also important in the pathophysiology of COVID-19 associated AKI. [ABSTRACT FROM AUTHOR]

As COVID-19 pandemic continues to test the medical world, due to rapid viral transmission and subsequent mutations, the old burning health crisis continues to surface, one of them being the blood shortage. The current situation has disrupted the fragile balance between blood donors and the real need of blood in hospitals, especially due to repetitive lock-downs, isolation, social-restrictions, and ongoing anxiety promoted by social media, threatening the quality of medical cares. [ABSTRACT FROM AUTHOR]

Hydrotherapy represents the use of water for medical purpose, being involved in burn wound care since the 17th century. Burn wound cleansing, performed daily, twice a day, or as needed, as part of standard care, should be scheduled by a burn surgeon and supervised by proper specialists. It can be performed by various methods, like shower, immersion, bedside irrigation or wiping. Due to the high risk of cross-contamination, immersion is no longer recommended. Tap water seems to be superior to saline solution in burn wound care, and adjuvants can be added, especially chlorhexidine, povidone-iodine, or special detergents. Disposable plastic sheets use during showering and the following of cleaning protocols for washing areas have decreased the risk of infection. Apart from the wound-cleansing role, hydrotherapy reduces itching and pain, improves wound healing, favours early mobilization and increases patients’ comfort. Controversy persists around the optimal method and appropriate solutions for cleaning burn injuries and clinical studies are further required to solve this matter. In the absence of standardized recommendations, most burn centers are guided by experience. [ABSTRACT FROM AUTHOR]

IgA Nephropathy (IgAN) is one of the most frequent types of glomerulonephritis encountered in adults from Western countries and Asia. IgAN is responsible for approximately 40% of end-stage renal disease (ESRD) mediated by glomerular impairment. The majority of adult IgAN patients present a slowly progressive pattern towards ESRD. Current types of treatment are based mainly on supportive care: i.e., life style risk factors, measures that lower blood pressure and reduce proteinuria, weight loss, smoking cessation or glycaemia control. Because IgAN is an immune complex-mediated disease, immunosuppression therapy gains more and more attention as a modality of treatment. Despite the beneficial effects, the value of immunosuppression remains controversial due to high rates of adverse reactions. The aim of this review is to highlight the benefits and limitations of promoting immunosuppression in IgAN with mild to moderate proteinuria despite supportive antiproteinuric therapy up titrated to maximum tolerated doses. [ABSTRACT FROM AUTHOR]

Immunoglobulin A (IgA) nephropathy is one of the most common glomerulonephritis. Its clinical manifestations vary from asymptomatic forms to cases with nephritic syndrome or nephrotic-range proteinuria. The prognosis depends on the level of proteinuria, decline of glomerular filtration rate and control of blood pressure. The pathognomonic histological changes are represented by the granular IgA deposits in the mesangium. The treatment consists of comprehensive support care and immunosuppressive therapy. We discuss the case of a 50-year-old man who presented microscopic hematuria, nephrotic-range proteinuria and decreased renal function, exacerbated in the last 6 months prior the admission. We performed a renal biopsy and granular deposits were present in the glomerular mesangium that were highly suggestive for IgA nephropathy. Immunosuppressive therapy was instituted immediately, but the decline of the renal function continued and renal replacement therapy was needed. Patients with poor prognosis have an unsatisfactory response to the immunosuppressants, especially those with a delayed diagnosis. [ABSTRACT FROM AUTHOR]

We present the case of a 82 years old women, who was admitted in our surgical clinic with two giant breast tumors, located on the left breast, with skin ulceration and suprainfection, accompanied by a big axillary mass in the left axilla. The patient was known with a previous rectal tumor, recently operated in another surgical service, for which it was an anterior rectal resection and definitive left colostomy done. The case is an atypical form of presentation of a Lynch II syndrome. The indication for total mastectomy and axillary lymphadenectomy was sustained by tumors' dimensions and suprainfection, although the case was oncologically overcome. [ABSTRACT FROM AUTHOR]