Rebecca Stein-Wexler, MD
Aim: To assess the prevalence of 3 Kaohsiung new cholesterol guidelines chart generic vytorin 20mg overnight delivery, Taiwan cholesterol levels chart pdf order vytorin visa, Province of China; Changhua County Public Health tobacco consumption among coal mine workers in Cuddalore District cholesterol zelf test kit vytorin 20mg visa, Tamil Bureau cholesterol synthesis chart order vytorin 30 mg on line, Changhua, Taiwan, Province of China Nadu, India. Methods: A cross-sectional descriptive survey was conducted among 603 coal mine workers in Cuddalore District. Simple random sampling Background: In Taiwan, Papanicolaou test for cervical cancer screening has been method was used to recruit the subjects. Informed consent was obtained from implemented since 1995, previous study has shown that Papanicolaou test can theparticipants. Apretestedquestionnairewasusedtocollectdataontobacco substantially decrease the cervical cancer incidence and mortality rates. Results: All 603 reached 70%, indicates the methods of inviting people to attend the Papanicolaou subjects were males. Aim:Ourstudy aimwasto evaluatetheeffectiveness of different invitation strategies stratified by frequency of clinic visiting per year using Totally, n5197 (32. Methods: the health bureau and local hospital ported of smoking habit, cigarette smoking was reported by n5172 (87. None of the Weenrolledtheeligiblewomenaged30ormorewhoneverattendtoundergocervical smokers reported of using smokeless form of tobacco. Conclusion: High prevcancer screening in recent three years to initiate a randomized control trial based on alence of tobacco smoking was observed among the workers. Basedonclinicvisitingrecordsinrecentyear organized initiatives by the health care professionals, management and the as hospital loyalty, participants are classified into three levels, including no clinic people should be taken to reduce the tobacco consumption. Common risk factor visiting history, 1-3 times, and 4 times or more of clinic visiting in 2005, and then approach and behavior counseling can be advocated to change their attitude randomlyallocatedintono-intervention,postcardinvitation,telephonecallreminding toward tobacco consumption. To start tobacco cessation clinics to aid the only, and telephone call with reservation appointment. To advertise about the ill effects of measured by whether the participant completes the Papanicolaou test within four tobacco by displaying pictures and information in public area and work places. Results: Using the intention-to-treat analysis, among those who without clinic visiting, compared with control group(nointervention),the result showsnosignificantbenefit of postcard reminding. After adjustment for other potential factors, the results show the strategies of invitation were postcard (adj. Regarding the different frequency of clinic visiting, compared with subjects without clinic visiting,thosewhowerehigherclinicalvisitingaretendtobeingattendeeofscreening and telephonecallwith schedulingappointmentishighereffectiveness,respectively. Conclusion: Telephone-call reminding only and telephone-call with scheduling appointment significantly increased Papanicolaou test participation rates in those who were low and high loyalty patients as well. At the same time, there is a dramatic Population Health, Belfast, United Kingdom; National Cancer Society Malaysia, increase in using genetics to support personalized medicine. These two Kuala Lumpur, Malaysia; 4Ministry of Health Malaysia, Putrajaya, Malaysia; 5 approaches would seem antithetical. Results: Data collection for this part of the larger study was completed to 40 range. Conclusion: in preparation for statistical analysis including x2tests of association and logistic Shifting from the current public health approach of primarily age-based screening for regression. Screening using fecal testing for occult blood, with follow-up dithe basis of genomic biomarkers. Radiogenomics studies on liver, lung and head-and-neck Methods: OncoSim is a microsimulation model led by the Canadian Partcancers have established the capability of radiomics analysis in capturing nership Against Cancer with model development by Statistics Canada. We intratumor heterogeneity with the identification of radiomics signatures that compared results of high quality follow-up colonoscopy after positive fecal are representative of underlying gene expression patterns. Conclusion: Reduced colonoscopy quality can lead to considerable declines in the predicted effectiveness of screening and to increased costs to the healthcare system. Increased mortality rates guidelines, which recommend screening from ages 50 to 75 years for avand advanced disease at presentation in comparison with developed erage risk individuals. Aim: In this study, we preventative methods individualized for the population at risk. Strategies differed with respect to test modality, ages to surveyed, with 300 from each cohort. While the urban cohort was more knowledgeable about Pap cremental colonoscopies per life-year gained. Nevertheless, urban participants were more colonoscopy screening every 10 years starting at age 45 years resulting in an knowledgeable about breast self exams (71% vs. Conclusion: Overall knowledge of every5yearswasrecommendedbythemodelasthesestrategiesprovidedsimilar breast and cervical cancer did not differ between both groups, despite life-years gained at an acceptable screening burden. Womenintheruralcohort demonstrated more awareness of several oncologic risk factors. Yet, the greater familiarity with and uptake of screening methods, especially for breast cancer, among women in the urban cohort may point to the benefits of Fig 1. Lifetime number of colonoscopies and life-years gained for colonoscopy proximity to health care infrastructure, such as tertiarycarecenters. In Victoria, Australia, survival is poorer for rural patients with tance and facilitated working groups that advance research on cancer screening, via colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to standardization of definitions, metrics, and measures, and cross-national comparative disparities,butpreviousstudieshavenotcomparedthetimelinessofruralandurbanpathways studies. Six intervals thetranslatabilityofcancerscreening knowledgebetween highandlow-resource settings were explored: patient (symptom to presentation), primary care (presentation to referral), to advance the field of cancer screening globally. Data Rural-urban differences were examined for each cancer using quantile regression (50th,75th collection consisted ofasurvey toourlistserv, whichhas666 subscribers. Results: There and 90th percentiles) models including age, gender, health insurance and socioeconomic were 266 network members who responded to the survey, including 244 advanced who status. Compared with urban patients, symptomatic colorectal screening for 15 or fewer years, although 27. These patients also had longer health system intervals, ranging 7-85 days members predominantly work in organized cancer screening programs (72. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Conclusion: Consistent with variation in survival, we found longer total and agreed that it enabled them to learn from cancer screening in lower resource settings. Countriesseekingtounderstandcancerdisparitiesintheirlocalcontextmayalso consider using a pathways approach to identify possible targets for policy intervention. Yoon,1 Lucknow, India MaGiC Investigators Background: the Lifeline Express or Jeevan Rekha Express is Worldfis first 1Cancer Research Malaysia, Subang Jaya, Malaysia; 2The University of hospital train run by the Impact India Foundation. It started on July 16, 1991; as of 2016 the service Australia; 5Monash University, School of Clinical Sciences at Monash Health, had completed almost 200 projects, benefiting over 900,000 rural Indians. Methods: the specialist surgeon was Centre, Department of Obstetric and Gynaecology, Kuala Lumpur, Malaysia; assigned a task screen and teach the importance of breast self examination 8University Malaya Medical Centre, Department of Paediatrics, Kuala Lumpur, Malaysia; 9Hospital Kuala Lumpur, Kuala Lumpur, Malaysia in the rural setting. The women were divided into batches of 50 and were shown a PowerPoint presentation with a video on breast self examination. Each lady was requested to teach a population-based cohort of ovarian cancer patients in Malaysia. Patients with breast cancer (6 ladies) August2016,womenwithnonmucinousepithelialovarian,peritonealorfallopiantube were appropriately referred and treated in a tertiary referral hospital. Other cancers like thyroid cancer and 325)patientsandnopathogenicvariantsweredetectedin73. Background: Many patients with cancer are diagnosed through an emerthe processes people undertake during symptom appraisal are impacted by gency presentation, which is associated with inferior clinical and patientnumerous factors, including culture. Aim: We aimed to explore culturally reported outcomes compared with those of patients who are diagnosed specific factors that impact symptom appraisaland help seeking for acancer electively or through screening. Reducing the proportion of patients with diagnosis in Vietnamese-speaking Australians and to develop a culturally cancer who are diagnosed as emergencies is, therefore, desirable; however, relevant community-based symptom awareness campaign. Methods: We the optimal means of achieving this aim are uncertain owing to the inused a mixed methods approach to survey and interview people who had not volvement of different tumor, patient and health-care factors, often in experienced cancer and interviewed people with a recent diagnosis of combination. Besides this cholesterol food sources discount 30 mg vytorin with mastercard, mental and emotional disturbances cause imbalances of the vital electric field within which cell metabolism takes place hdl cholesterol in quail eggs order vytorin from india, producing toxins cholesterol medication and muscle pain order vytorin uk. When the soil of this electric filed is undisturbed cholesterol in shrimp cocktail discount vytorin 20mg visa, disease-causing germs can live in it without multiplying or producing toxins. It is only when it is disturbed or when the blood is polluted with toxic waste that the germs multiply and become harmful. Basic Principles the whole philosophy and practice of nature cure is built on three basic principles. These principles are based on the conclu sions reached from over a century of effective naturopathic treatment of diseases in Germany, America and Great Britain. These waste materials in the healthy individual are removed from the system through the organs of elimination. But in the diseased person, they are steadily piling up in the body through years of faulty habits of living such as wrong feeding, improper care of the body and habits contributing to enervation and nervous exhaustion such as worry, overwork and excesses of all kinds. It follows from this basic principle that the only way to cure disease is to employ methods which will enable the system to throw off these toxic accumulations. The second basic principle of nature cure is that all acute diseases such as fevers, colds, inflammations, digestive disturbances and skin eruptions are nothing more than self-initiated efforts on the part of the body to throw off the accumulated waste materials and that all chronic diseases such as heart disease, diabetes, rheumatism, asthma, kidney disorders, are the results of continued suppression of the acute diseases through harmful methods such as drugs, vaccines, narcotics and gland extracts. The third principle of nature cure is that the body contains an eleborate healing mechanism which has the power to bring about a return to normal condition of health, provided right methods are employed to enable it to do so. In other words, the power to cure disease lies within the body itself and not in the hands of the doctor. Nature Cure vs Modern System the modern medical system treats the symptoms and suppresses the disease but does little to ascertain the real cause. Toxic drugs which may suppress or relieve some ailments usually have harmful side-effects. Drugs usually hinder the self-healing efforts of the body and make recovery more difficult. According to the late Sir William Osler, an eminent physician and surgeon, when drugs are used, the patient has to recover twice once from the illness, and once from the drug. Drugs also produce dietary deficiencies by destroying nutrients, using them up, and preventing their absorption. Moreover, the toxicity they produce occurs at a time when the body is least capable of coping with it. The approach of modern system is more on combative lines after the disease has set in, whereas nature cure system lays greater emphasis on preventive method and adopts measures to attain and maintain health and prevent disease. Methods of Nature Cure the nature cure system aims at the readjustment of the human system from abnormal to normal conditions and functions, and adopts methods of cure which are in conformity with the constructive principles of nature. Such methods remove from the system the accumulation of toxic matter and poisons without in any way injuring the vital organs of the body. They also stimulate the organs of elimination and purification to better functioning. To get rid of accumulated toxins and restore the equilibrium of the system, it is desirable to completely exclude acid-forming foods, including proteins, starches and fats, for a week or more and to confine the diet to fresh fruits which will disinfect the stomach and alimentary canal. If the body is overloaded with morbid matter, as in acute disease, a complete fast for a few days may be necessary for the elimination of toxins. A simple rule is: do not eat when you are sick, stick to a light diet of fresh fruits. Alkaline foods such as raw vegetables and sprouted whole grain cereals may be added after a week of a fruits-only diet. Another important factor in the cure of diseases by natural methods is to stimulate the vitality of the body. This can be achieved by using water in various ways and at varying temperatures in the form of packs or baths. The application of cold water, especially to the abdomen, the seat of most diseases, and to the sexual organs, through a cold sitting (hip) bath immediately lowers body heat and stimulates the nervous system. Other natural methods useful in the cure of diseases are air and sunbaths, exercise and massage. Exercise, especially yogic asanas,promotes inner health and harmony and helps eliminate all tension: physical, mental and emotional. Massage tones up the nervous system and quickens blood circulation and the metabolic process. Thus a well-balanced diet, sufficient physical exercise, the observation of the other laws of well-being such as fresh air, plenty of sunlight, pure drinking water,scrupulous cleanliness, adequate rest and right mental attitude can ensure proper health and prevent disease. The Mohammedan, the Buddhists, the Hindus and many others have their periods of strict fasting. Fasting indisease was advocated by the school of natural philosopher, Asclepiades, more than two thousand years ago. Throughout medical history, it has been regarded as one of the most dependable curative methods. Hippocrates, Galen, Paracelsus and many other great authorities on medicine prescribed it. Many noted modern physicians have successfully employed this system of healing in the treatment of numerous diseases. The common cause of all diseases is the accumulation of waste and poisonous matter in the body which results from overeating. The majority of persons eat too much and follow sedentary occupations which do not permit sufficient and proper exercise for utilisation of this large quantity of food. This surplus overburdens the digestive and assimulative organs and clogs up the system with impurities or poisons. Digestion and elimination become slow and the functional activity of the whole system gets deranged. The onset of disease is merely the process of ridding the system of these impurities. Every disease can be healed by only one remedy by doing just the opposite of what causes it, that is, by reducing the food intake or fasting. By depriving the body of food for a time,the organs of elimination such as the bowels, kidneys, skin and lungs are given opportunity to expel, unhampered, the overload of accumulated waste from the system. Thus, fasting is merely the process of purification and an effective and quick method of cure. It assists nature in her continuous effort to expel foreign matter and disease producing waste from the body, thereby correcting the faults of improper diet and wrong living. It also leads to regeneration of the blood as well as the repair and regeneration of the various tissues of the body. Duration the duration of the fast depends upon the age of the patient, the nature of the disease and the amount and type of drugs previously used. The duration is important, because long periods of fasting can be dangerous if undertaken without competent professional guidance. It is, therefore, advisable to undertake a series of short fasts of two to three days and gradually increase the duration of each succeeding fast by a day or so. This will enable the chronically sick body to gradually and slowly eliminate toxic waste matter without seriously affecting the natural functioning of the body. A correct mode of living and a balanced diet after the fast will restore vigour and vitality to the individual. Fasting is highly beneficial in practically all kinds of stomach and intestinal disorders and in serious conditions of the kidneys and liver. It is a miracle cure for eczema and other skin diseases and offers the only hope of permanent cure in many cases. In cases of diabetes, advanced stages of tuberculosis, and extreme cases of neurasthenia, long fasts will be harmful. Although the old classic form of fasting was a pure water fast, most ofthe leading authorities on fasting today agree that juice fasting is far superior to a water fast. Rangar Berg, the world famous authority on nutrition, "During fasting the body burns up and excretes huge amounts of accumulated wastes. Discount vytorin 30 mg overnight delivery. कोलेस्ट्रॉल में क्या खाएं क्या न खाएं | Cholestrol Me kya Khaye Kya Na Khaye? -1.
Strategies may include using hormones at a lower dose or for a limited period of time cholesterol bad vytorin 20mg on line. Nonbinary people on the feminine spectrum may choose to only use an androgen blocker cholesterol test labcorp order 30 mg vytorin with visa, and/or use estrogen at a very low dose cholesterol ratio nz purchase vytorin australia, or for a short time cholesterol ratio units buy discount vytorin 20 mg online. For those on the masculine spectrum, low dose testosterone can be acceptable, especially if menses is not a source of dysphoria, as low dose may not stop menses. These could include intramuscular medroxyprogesterone, the levonorgestrel intrauterine system or an etonogestral implant, all of which also provide contraception. On occasion, masculine spectrum clients might choose continuous combined oral contraceptives for cessation of menses as well as for contraception. Surgical options for cessation of menses may include uterine ablation or hysterectomy. It is important to remember to address reproductive and fertility considerations as part of informed consent for medical and surgical approaches, discussed in greater detail in other sections of this protocol. Some desired combinations of results (such as a deepened voice without facial or body hair growth) may not be possible. A masculine spectrum nonbinary person may choose to keep their vagina when pursuing metoidioplasty; this is also an option for a more traditionally binary transgender man. A feminine spectrum nonbinary person may choose to have vaginoplasty but not desire breast development and not pursue hormonal transition; in these cases hormone replacement will be necessary after gonadectomy to maintain bone health, and surgery should only be pursued after an appropriate evaluation by an experienced and qualified mental health provider. Other considerations: Challenges for the gender nonbinary person include the lack of nonbinary gender markers for documentation in medical records and in legal identification, such as passports and drivers licenses. Advocacy groups are making efforts to challenge the binary system, introducing nonbinary gender concepts and terminology into legal, medical, mental health, and educational arenas. A more substantial discussion of gender nonbinary experiences can be found in blogs and websites. June 17, 2016 71 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 11. A 2010 Cochrane analysis found no interaction between menopausal hormone therapy and all-cause mortality, cardiovascularrelated mortality, non-fatal myocardial infarction or angina, or the need for bypass surgery or coronary angioplasty. Larger studies have been retrospective and did not adjust for numerous coexisting risk factors. Any analysis of the possible negative effects of hormone therapy on cardiovascular disease and stroke should take into consideration the significant benefits of hormone therapy on quality of life and psychosocial functioning. Some studies have found increased morbidity and mortality from myocardial infarction and stroke compared with nontransgender men, however these studies did not adjust for a number of risk factors including tobacco use, obesity, and diabetes. All-cause as well as cardiovascularand cerebrovascular-specific mortality among transgender men did not differ from the general Dutch population. Direct study of the effects of hormones on lipids and blood pressure in transgender people has been limited. A retrospective study of lipids in 169 Austrian transgender people found trends of poorer lipid profiles in both transgender women and men at 5 years however these changes were mild at most, and seemed to be mitigated to some degree by the use of transdermal estradiol. Currently there is no guidance on whether to use risk calculators based on natal sex or affirmed gender. It may be reasonable to use natal sex-based calculators in transgender people who have transitioned later in life, given their long-term exposure to the natal hormonal milieu. However with an increasing percentage of transgender people beginning hormone therapy in adolescence and young adulthood, affirmed gender-based calculators may be more appropriate in these cases. Ultimately a primary goal is to calculate a realistic risk-benefit ratio between the benefits of statin therapy or aspirin and the risks of these treatments. Depending on the age at which hormones are begun and total length of exposure, providers may choose to use the risk calculator for the natal sex, affirmed gender, or an average of the two (Grading: X C M). Another goal of calculating risk is to provide adequate information during the informed consent process to allow transgender people of any age, and with or without existing cardiovascular or cerebrovascular disease, to make informed decisions about the long term implications of gender-affirming hormones. It is theoretically possible that the psychosocial benefits of hormone therapy may June 17, 2016 73 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People have an independent and protective effect through reduction of stress, improved body image resulting in healthier lifestyle choices, reduced tobacco use, and increased physical activity. Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern. An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. June 17, 2016 74 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 11. Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses. Cross-sex hormone therapy alters the serum lipid profile: a retrospective cohort study in 169 transsexuals. Effects of oral and transdermal estrogen replacement therapy on markers of coagulation, fibrinolysis, inflammation and serum lipids and lipoproteins in postmenopausal women. June 17, 2016 75 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 12. The effect of gender-affirming hormone therapy on diabetes risk or disease course is unclear. A Dutch case-control study noted an increased prevalence of type 2 diabetes mellitus among transgender men and women in comparison to both age matched non-transgender male and female groups, however the study did not adjust for other risk factors. While insulin resistance serves as a useful surrogate marker to inform risk, outcome studies using a diagnosis of diabetes as the end point have not been conducted. Otherwise young and healthy transgender people will often seek medical care with the sole purpose of obtaining hormone therapy or surgery. This can be viewed as an opportunity to improve health particularly in transgender women, who may be at increased cardiovascular risk. However, caution should be used to avoid making gender-affirming care contingent on tight control of these other conditions. Numerous anecdotes exist of poorly controlled diabetic transgender patients who had improvements in self-care and resultant decline in hemoglobin A1c after initiation of gender-affirming hormones. Testosterone package inserts recommend monitoring as serum glucose may be lowered in patients with diabetes receiving testosterone. It is reasonable to maintain heightened monitoring of indicators such as fasting glucose and hemoglobin A1c when initiating or adjusting hormone therapy. Patients with diabetes seeking gender-affirming surgeries represent a special group for whom aggressive treatment to normalize glucose control is desirable. Healing, avoidance of infection, June 17, 2016 76 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People functionality and cosmesis are thought to be improved with better glycemic control. While the presence of diabetes in itself may not be a contraindication for any of these surgeries, careful coordination between the surgeon and the provider managing the diabetes is recommended. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Effects of testosterone on Type 2 diabetes and components of the metabolic syndrome. Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan. Management of medical morbidities and risk factors before surgery: smoking, diabetes, and other complicating factors. June 17, 2016 77 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 13. Osteoporosis screening is currently ageand sexbased, and also individualized on the basis of risk factors. There are a number of lifestyle, genetic, endocrinologic, hematologic, rheumatoid and autoimmune diseases, as well as medications that contribute to osteoporosis. Known risk factors for osteoporosis include underutilization of hormones after gonadectomy or use of androgen blockers without or with insufficient estrogen. Osteoporosis risk in transgender men Most published studies to date have shown either no change, or an increase in bone mineral density in transgender men treated with testosterone. Risk factors for osteoporosis in this population include oophorectomy before age 45 without optimal hormone replacement.
This cycle can be quite troublesome and also is associated with a risk for the development of an aggressive skin cancer cholesterol ranges hdl vytorin 20 mg without prescription. Acceptable Settings for Secondary Closure Wounds that will heal with an acceptable scar if the skin edges are not sutured together can be allowed to heal secondarily cholesterol of 200 generic vytorin 20 mg on line. Be sure to keep in mind the above caveats when wounds > 2 cm are allowed to close by secondary intention cholesterol test ireland order vytorin toronto. Secondary Closure as the Treatment of Choice Some wounds should not be closed with sutures blood cholesterol levels nz discount vytorin 20 mg without prescription. Instead, they should be left open and treated with dressing changes until they heal. With the exception of facial wounds, you should not use primary repair for a wound that is more than 6 hours old. Examples of dirty wounds include human bites on the hand or wounds deeply embedded with dirt or grass. Sometimes empty space rather than subcutaneous tissue is seen beneath the repaired skin when you try to bring the skin edges together. If such wounds are closed primarily, the risk for blood collecting under the skin closure is high, increasing the likelihood of infection and problems with wound healing. After the skin is sutured together, the underlying tissues are not well approximated. This dead space promotes hematoma (a collection of old blood) formation and infection. A tight skin closure decreases blood circulation to the skin edges, thereby causing the tissues to become ischemic (low supply of oxygen and nutrients). Skin death results in a wound that is larger than the initial wound and even more problematic to close. These are wounds that are associated with exposure of an important underlying structure or are located in areas where a tight scar will be particularly problematic. If primary closure is not possible, one of the other options from the reconstructive ladder must be chosen (see following chapters). Exposure of a Vital Structure Sometimes wounds occur over important structures such as fracture sites, tendons, or prosthetic devices. If these structures are not covered by healthy soft tissue, there is an almost 100% risk for the structure to become infected or die. To avoid permanent disability, a wound that results in exposure of an important structure should optimally be closed quickly (within days) with healthy tissue. The scar that results from secondary closure will cause tightness across the crease and may result in significant limitation of movement. Face Wounds Near the Lower Eyelid In many areas of the face, a wound can be allowed to heal secondarily without significant cosmetic ill effects. However, wounds on the cheek near the lower eyelid may pull the eyelid downward if allowed to heal secondarily. The result not only is cosmetically unacceptable but also may expose the eye to injury. Guidelines for Use of Secondary Closure If you decide to treat a wound by secondary intention, the wound must be evaluated thoroughly and cleaned rigorously. Secondary Wound Closure 89 Unless the wound involves a human or a deep animal bite, antibiotics (oral or intravenous) are not required. However, you should see the patient within a few days to ensure that no signs of infection are present and that the wound is being cared for properly. Signs of Infection Signs of wound infection include redness, warmth, swelling, and tenderness in the tissues around the wound. A green, somewhat sweet-smelling, creamy material is a sign of colonization by Pseudomonas bacteria. You may start with a dressing regimen of antibiotic ointment covered with dry gauze. At this point you should change to a wet-to-dry dressing and observe how the wound progresses. Once the wound has improved in appearance, you can go back to the antibiotic ointment or continue with the wet-to-dry dressings. Duration of Wound Dressing the dressings should be continued until the wound heals. Often during the course of secondary healing, the wound develops a dry eschar (scab). If the wound is near a crease, encourage the patient to exercise the area to prevent formation of a tight scar. Whenever possible and practical, primary closure is the best way to close an acute open wound. Contraindications to Primary Wound Closure Concern about wound infection is the main reason not to close a wound primarily. If infection develops, the resultant deformity may be worse than that caused by the initial injury alone. Anesthetize the Area Before Suturing If local anesthetic was administered for wound cleansing, check to ensure that the anesthesia is still effective. Pinch the tissues with your forceps, or gently touch the skin edges with a needle. With adequate anesthesia, the patient may still feel a sensation of pressure when you pinch the tissues with the forceps, but it should not hurt. For wounds of the face or scalp, the addition of epinephrine decreases bleeding caused by the placement of sutures. The larger the number, the smaller the needle: a 25-gauge needle is much smaller than an 18-gauge needle. If the tissues are dirty, however, inject into the skin surrounding the wound to prevent foreign material from being pushed into the uninjured surrounding tissues. Primary Wound Closure 93 How to Suture the Wound Most wounds can be closed by suturing the skin edges together. Suture Size On the Face Small sutures such as 5-0 or 6-0 should be used to repair facial lacerations. Nonabsorbable Sutures For most skin suturing, nonabsorbable sutures are best because they are associated with less noticeable scarring. Exceptions include patients who cannot return for suture removal, children (because of the difficulty in removing sutures from a frightened, crying child), and some facial lacerations. Continuous Closure In an interrupted closure, you tie the suture once it has passed through each side of the wound. In a continuous closure, you place the sutures one right after the other without tying each suture individually. |
