Bakgrund: Svårläkta sår är ett hälsoproblem världen över. Kontinuitet, personcentrerad vård, korrekt sårbedömning och tillämpad kunskap om sårläkningsprocessen och bakomliggande faktorer ligger till grund för god sårläkning. Distriktssköterskans handhavande och kunskaper är betydelsefulla faktorer i vården av patienter med svårläkta sår. Tvärprofessionell vård och personcentrerad vård är viktiga komponenter i vårdplanen av patienter med svårläkta sår. Syfte: Syftet är att undersöka distriktssköterskans handhavande av och kunskaper om svårläkta sår. Metod: Denna enkätstudie är en empirisk tvärsnittsstudie med analys av kvantitativ data och deskriptiv design. Urvalsgruppen bestod av sjuksköterskor och distriktssköterskor arbetsverksamma inom primärvården och den kommunala hemsjukvården i två län i sydöstra Sverige. Resultat: Analysen resulterade i fyra framträdande fynd. De mest framträdande fynden är: kollegor, arbetslivserfarenhet och fortbildning är de främsta kunskapskällorna angående svårläkta sår och fortbildning i sårvård erbjuds sällan. Distriktssköterskor graderar sina kunskaper om svårläkta sår högre än sjuksköterskor, det finns skillnader mellan arbetsplatser och län i vilka läkningshämmande faktorer som arbetas aktivt med samt att det tvärprofessionella samarbetet skiljer sig mellan arbetsplatser och län. Slutsats: Det finns skillnader i utbildningen inom sårvård mellan sjuksköterskeutbildningen och distriktssköterskeutbildningen, därav har kunskapsbyte mellan kollegor och fortbildning blivit en viktig faktor för högre kompetens inom sårvård. I dagsläget finns det inga nationella riktlinjer och rutiner i hur sårvården bör utformas utan det skiljer sig mellan olika län, primärvård och kommunal hemsjukvård. / Background: Chronic wounds are a health problem all over the world. Continuity, person-centered care, proper wound assessment and applied knowledge of the wound healing process and underlying factors underpin good wound healing. District nurses handling and knowledge are important factors in the care of patients with chronic wounds. Cross-professional care and person-centered care are important components of the care plan of patients with chronic wounds. Purpose: The purpose is to investigate the district nurse disposal and knowledge of severe wounds. Method: This survey is an empirical cross-sectional study with analysis of quantitative data and descriptive design. The selection group consisted of general nurses and district nurses employed in primary care and community home care in two counties in southeast Sweden. Results: The analysis resulted in four prominent findings. The most prominent findings are: colleagues, work experience and continuing training are the main sources of knowledge regarding chronic wounds and wound care training is rarely offered. District nurses grade their knowledge of chronic wounds higher than general nurses, there are differences between workplaces and counties in which anti-healing factors are actively working whit and that cross-professional cooperation differs between workplaces and counties. Conclusion: There are differences in education in wound care between nursing education and district nursing education, hence the exchange of knowledge between colleagues and continuing education has become an important factor for higher wound care skills. Today there are no national guidelines and procedures in how wound care should be designed, there are differences between counties, primary care and community home care

Orientador: Elenice Deffune / Resumo: Feridas crônicas consistem em lesões que não cicatrizam espontaneamente ou recorrentes, mesmo após o tratamento em período superior a três semanas. O processo de restauração da pele é complexo e interdependente, defronta-se com diversos fatores locais ou sistêmicos que interferem na cicatrização, além das interferências culturais e econômicas na escolha do tratamento. Atualmente existem vários recursos terapêuticos, práticas integrativas e complementares, que auxiliam o profissional e o portador na definição e maior adesão ao tratamento. Objetivos: Identificar o saber popular referido por pacientes em tratamento de feridas crônicas, no ambulatório de biocurativo no período de 2007-2010 e analisar o estado da arte sobre o uso de práticas integrativas e complementares através de uma revisão bibliográfica. Material e método: Foram consultados arquivos do Ambulatório de Biocurativo e do Laboratório de Engenharia Celular de portadores de feridas crônicas sobre a escolha do tratamento e através de pesquisa em base de dados construção de uma contextualização de tipos de tratamentos. Conclusão: Majoritariamente o saber popular é transmitido pelos pais, de geração a geração, com orientações de restrições alimentares de proteína, utilização de plantas medicinais para auxiliar na cicatrização. Quanto ao uso de práticas integrativas identificou-se que muitas delas não encontram-se baseadas em evidências, mas não tendo contraindicações, devem ser aceitas sob revisão periódica da equipe de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Chronic wounds consist of injuries which do not heal spontaneously, or recur, even after treatment longer than three weeks. The process of skin restoration is complex and interdependent; it encounters several local or systemic factors that interfere in healing, besides the cultural and economic interferences in the choice of treatment. Currently there are several therapeutic resources, integrative and complementary practices which help the professional and the patient on the definition and greater adhesion to the treatment. Objectives: To identify the popular knowledge referred to by patients, in the treatment of chronic wounds in the bio-curative outpatient clinic, between 2007-2010 and to analyze the state of the art on the use of integrative and complementary practices through a bibliographic review. Material and method: Archives of the Bio-curative Outpatient Clinic and the Cellular Engineering Laboratory of chronic wound patients and a database were searched, concerning the choice of treatment, aiming to elaborate a contextualization of types of treatments. Conclusion: Most popular knowledge is transmitted by parents, from generation to generation, comprising guidelines of protein food restrictions, use of medicinal plants to aid in healing. Regarding the use of integrative practices, it was identified that many of them are not based on evidences, but not presenting contraindication, they should be accepted under periodic review of the assistance team, as a motivation fo... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-20Bitstream added on 2014-06-13T20:29:57Z : No. of bitstreams: 1 felix_mc_me_botfm.pdf: 826136 bytes, checksum: 72fc2c810c332854ebb2731816d7b138 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / As doenças crônico-degenerativas são caracterizadas por uma evolução lenta e progressiva, muitas vezes irreversível e por um longo período de latência. Resultam em alterações celulares que são importantes fatores de risco para a disfunção endotelial facilitando o desenvolvimento de úlceras venosas e/ou isquêmicas e “pé diabético”. O antígeno K do sistema eritrocitário Kell constitui um potente peptídeo bioativo com várias funções biológicas, dentre elas a vasoconstrição que influenciam diretamente nas doenças vasculares. As plaquetas, quando ativadas, liberam fatores de crescimento que aceleram o processo de cicatrização. Na membrana plaquetária são expressos antígenos como os eritrocitários, o polimórfico HLA-classe I e antígenos específicos das plaquetas (HPA), e alguns deles possuem importante significância clínica. O conhecimento e a compreensão dos fatores de crescimento existentes nas plaquetas levaram o setor de Biotecnologia do Hemocentro de Botucatu ao desenvolvimento de produtos que utilizam plaquetas e plasma homólogos excedentes da rotina transfusional como princípios ativos na composição de um gel empregado na forma de curativos com o objetivo de acelerar o processo de reparo tecidual. Sabendo os efeitos benéficos dos curativos bioativos no processo de cicatrização e da variabilidade genética dos antígenos plaquetários, qualquer situação em que ocorra exposição a esses antígenos poderia levar a uma resposta imune humoral. Diante dessa assertiva o presente estudo teve por finalidade avaliar o potencial imunogênico desses curativos em pacientes submetidos a essa terapêutica. Foi realizado um estudo multicêntrico, onde um total de 198 pacientes que receberam os curativos bioativos foram fenotipados para presença do antígeno Kell. Dentre esses pacientes, 100 foram selecionados para avaliar a relação dos antígenos... / The chronic-degenerative diseases are characterized by a slow and gradual evolution, often irreversible, and with a long period of latency. Resulting in cellular changes that are important risk factors for endothelial dysfunction facilitating the development of venous ulcers and/or ischemic and diabetic foot. The antigens of the erythrocyte Kell is a potent bioactive peptide with various biological functions among which vasoconstriction that directly influence the vascular diseases. Platelets, when activated, release growth factors that accelerate the healing process. Platelet membrane express antigens as the erythrocyte, the polymorphic HLA class I-specific antigens and of platelets (HPA), and some have important clinical significance. Knowledge and understanding of the growth factors present in platelets led the biotechnology sector from the Bloodbank of Botucatu to develop products using platelets and plasma counterparts surplus of routine transfusion as active ingredients in the composition of a gel used as a dressing with the objective to accelerate the process of tissue repair. Given the beneficial effects of bioactive dressings in the process of healing and the genetic variability of platelet antigens, a situation occurs where exposure to these antigens could lead to a immune response. Given this assertion this study was to evaluate the potential immunogenic effect of these dressings in patients undergoing such therapy. This was a multicenter study, where a total of 198 patients who received the bioactive dressings were phenotyped for the presence of Kell antigen. Among these patients, 100 were selected to assess the relationship of erythrocyte antigens of the ABO and Rh in the process of healing and alloimmunization anti-erythrocyte. Also, 38 were selected to evaluate the immunogenic potential of bioactive dressings through the search of anti-HLA and -HPA alloimmunization... (Complete abstract click electronic access below)

Orientador: Rosana Rossi Ferreira / Banca: Rejane Tommazini Grotto / Banca: Vânia Nieto Brito de Souza / Resumo: As doenças crônico-degenerativas são caracterizadas por uma evolução lenta e progressiva, muitas vezes irreversível e por um longo período de latência. Resultam em alterações celulares que são importantes fatores de risco para a disfunção endotelial facilitando o desenvolvimento de úlceras venosas e/ou isquêmicas e "pé diabético". O antígeno K do sistema eritrocitário Kell constitui um potente peptídeo bioativo com várias funções biológicas, dentre elas a vasoconstrição que influenciam diretamente nas doenças vasculares. As plaquetas, quando ativadas, liberam fatores de crescimento que aceleram o processo de cicatrização. Na membrana plaquetária são expressos antígenos como os eritrocitários, o polimórfico HLA-classe I e antígenos específicos das plaquetas (HPA), e alguns deles possuem importante significância clínica. O conhecimento e a compreensão dos fatores de crescimento existentes nas plaquetas levaram o setor de Biotecnologia do Hemocentro de Botucatu ao desenvolvimento de produtos que utilizam plaquetas e plasma homólogos excedentes da rotina transfusional como princípios ativos na composição de um gel empregado na forma de curativos com o objetivo de acelerar o processo de reparo tecidual. Sabendo os efeitos benéficos dos curativos bioativos no processo de cicatrização e da variabilidade genética dos antígenos plaquetários, qualquer situação em que ocorra exposição a esses antígenos poderia levar a uma resposta imune humoral. Diante dessa assertiva o presente estudo teve por finalidade avaliar o potencial imunogênico desses curativos em pacientes submetidos a essa terapêutica. Foi realizado um estudo multicêntrico, onde um total de 198 pacientes que receberam os curativos bioativos foram fenotipados para presença do antígeno Kell. Dentre esses pacientes, 100 foram selecionados para avaliar a relação dos antígenos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The chronic-degenerative diseases are characterized by a slow and gradual evolution, often irreversible, and with a long period of latency. Resulting in cellular changes that are important risk factors for endothelial dysfunction facilitating the development of venous ulcers and/or ischemic and "diabetic foot." The antigens of the erythrocyte Kell is a potent bioactive peptide with various biological functions among which vasoconstriction that directly influence the vascular diseases. Platelets, when activated, release growth factors that accelerate the healing process. Platelet membrane express antigens as the erythrocyte, the polymorphic HLA class I-specific antigens and of platelets (HPA), and some have important clinical significance. Knowledge and understanding of the growth factors present in platelets led the biotechnology sector from the Bloodbank of Botucatu to develop products using platelets and plasma counterparts surplus of routine transfusion as active ingredients in the composition of a gel used as a dressing with the objective to accelerate the process of tissue repair. Given the beneficial effects of bioactive dressings in the process of healing and the genetic variability of platelet antigens, a situation occurs where exposure to these antigens could lead to a immune response. Given this assertion this study was to evaluate the potential immunogenic effect of these dressings in patients undergoing such therapy. This was a multicenter study, where a total of 198 patients who received the bioactive dressings were phenotyped for the presence of Kell antigen. Among these patients, 100 were selected to assess the relationship of erythrocyte antigens of the ABO and Rh in the process of healing and alloimmunization anti-erythrocyte. Also, 38 were selected to evaluate the immunogenic potential of bioactive dressings through the search of anti-HLA and -HPA alloimmunization... (Complete abstract click electronic access below) / Mestre

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-10-07T12:58:49Z No. of bitstreams: 2 Dissertação - Letícia Melo Oliveira - 2016.pdf: 2689005 bytes, checksum: 4e3895369da92424b67711e727c5f89b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-10-07T12:59:18Z (GMT) No. of bitstreams: 2 Dissertação - Letícia Melo Oliveira - 2016.pdf: 2689005 bytes, checksum: 4e3895369da92424b67711e727c5f89b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-10-07T12:59:18Z (GMT). No. of bitstreams: 2 Dissertação - Letícia Melo Oliveira - 2016.pdf: 2689005 bytes, checksum: 4e3895369da92424b67711e727c5f89b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-08-05 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / One of the complications of diabetes is the difficulty of wound healing. Several studies are being conducted in order to find a drug to optimize healing while taking a low cost. Calendula officinalis in homeopathic materia medica is cited as a healing agent, but no studies in the literature evaluating its effect on wounds in diabetic patients has been peeformed. Chitosan is a biopolymer that has anti-inflammatory, antibacterial, and antioxidant potential and helps in the healing process. The objective of this study was to evaluate and compare the effect of Calendula officinalis 6 CH and Chitosan Spray on the healing of skin wounds in diabetic rats. For this, we used 54 female rats randomly assigned into three groups (CG, GH, and GQ) 18 animals each satisfaction. The animals were treated according to the group to which they belonged: the CG with 0.9% saline, the GH with Calendula officinalis 6 CH, and GQ with Chitosan Spray. Each group was divided into three subgroups (n = 6) corresponding to periods of microscopic evaluation (three, seven, and 14 days). The rats were diabetes- induced by intraperitoneal application of Aloxana (120mg / kg) and then anesthetized for holding the punch of 9.0 mm in the dorsal thoracic vertebrae. Macroscopic and microscopic evaluations were performed. Macroscopically, animals treated with Calendula 6 CH and Chitosan Spray had their wounds healed in a shorter time when compared to the CG. Microscopically, we observed that the Calendula 6 CH was able to promote increased recruitment of mononuclear cells present in fibroplasia in the initial healing stage and promote formation of thick dense connective tissue and organized at the end of 14 days, demonstrating superiority to the control group and to the Chitosan group. The Chitosan Spray was effective and superior in optimizing wound healing compared to the control group. / Uma das complicações do diabetes é a dificuldade de cicatrização de feridas. Vários estudos estão sendo realizados no intuito de encontrar um medicamento capaz de otimizar a cicatrização tendo ao mesmo tempo um baixo custo. A Calendula officinalis na matéria médica homeopática é citada como agente cicatrizante, porém não há na literatura trabalhos avaliando sua ação sobre feridas em pacientes diabéticos. A quitosana é um biopolímero que apresenta potencial anti-inflamatório, antibacteriano e antioxidante e contribui no processo cicatricial. Objetivou-se com este estudo avaliar e comparar o efeito da Calendula officinalis 6 CH e do Spray de Quitosana na cicatrização de feridas cutâneas em ratas diabéticas. Para isto, foram utilizadas ratas Wistar divididas aleatoriamente em três grupos (GC, GH e GQ). Os animais foram tratados de acordo com o grupo a qual pertenciam: os do GC com solução salina 0,9%, os do GH com Calendula officinalis 6 CH e os do GQ com o Spray de Quitosana. Cada grupo foi subdividido em três subgrupos (n=6) correspondente aos períodos de avaliação microscópica (três, sete e 14 dias). As ratas foram induzidas ao diabetes por meio de aplicação intraperitoneal de Aloxana (120mg/kg) e então anestesiadas para a realização do punch de 9,0 mm na região dorsal às vertebras torácicas. Foram realizadas avaliações macroscópicas e microscópicas. Macroscopicamente os animais tratados com Calendula 6 CH e Spray de Quitosana tiveram suas feridas cicatrizadas em um menor tempo quando comparados ao GC. Microscopicamente foi possível observar que a Calendula 6 CH foi capaz de promover maior recrutamento de células mononucleares, apresentar fibroplasia no estágio inicial de cicatrização e promover formação de tecido conjuntivo denso espesso e organizado ao final de 14 dias, demonstrando superioridade ao grupo Controle e ao grupo Quitosana. O Spray de Quitosana se mostrou eficaz e superior na otimização da cicatrização de feridas em relação ao GC.

Wound care is a difficult process in the healthcare sector, especially the problem with chronic and infected wounds. There are a lot of patients suffering from these wounds and it is both painful and time consuming for nurses and patients. A wound on the verge of slowing down in the healing process has a shift in its pH value from acidic to neutral and alkaline. If healthcare staff could easily identify this change the chances of treating the wound in time increases, which could stop the developing of a chronic wound. This report aims to research the possibilities of textile materials that can respond to pH changes and be used in the healthcare sector as a wound dressing. If this becomes a reality, it can both reduce the number of patients suffering from infected and chronic wounds and facilitate the efficiency of healthcare workers' work. Through interviews and a selective reading into the subjects of: pH, chronic wounds and wound dressings, textile materials and healthcare requirements sketches and ideas were created on how to incorporate a pH indicator into a textile material and through this: into a wound dressing. What was found was that the technique of electrospun polyamide together with bromocresol purple (pH indicator) in the solution creates a highly suitable fiber for use in pH monitoring wound care. The fiber provides the possibility to construct a fabric, that have the application of detecting and changing color between the pH values in the range between 5.2-6.8, which is the critical pH range for healing wounds. Wound dressing that's interacting with healthcare staff and provides clues on how the wound is evolving could be the future of wound dressings. Not just to create the perfect environment for the wound but actively analyzing on how it is healing.

Bakgrund Kroniska sår kan medföra lidande samt ha negativ inverkan på livskvalitet för individen som drabbas. Kroniska sår kan även innebära ökade kostnader för samhället. Kroniska sår drabbar särskilt äldre människor och kan ha sitt ursprung i flera faktorer. Vårdens primära mål för dessa sår är vanligtvis att uppnå läkning men för patienter med kroniska sår kan ett lindrat lidande vara lika viktigt. Det finns dock brister gällande kunskap inom vården hur behoven hos patientgruppen med kroniska sår ska uppnås. Att beskriva hur patienter med kroniska sår upplever lidandet kan ge ökad medvetenhet om faktorer som är betydelsefulla för denna patientgrupp och således bidra till ökad kunskap hos vårdpersonal när det gäller lidandet vid kroniska sår. Syfte Syftet var att beskriva patienters upplevelser av lidande vid behandling av kroniska sår. Metod En icke-systematisk litteraturöversikt där 17 vetenskapliga originalartiklar med både kvalitativ och kvantitativ ansats inkluderades. Artiklarna inhämtades i databaserna PubMed och CINAHL genom att använda sökordskombinationer och manuella sökningar. Artiklarna kvalitetsgranskades och en integrerad analys av de inkluderade artiklarna genomfördes. Resultat Två huvudrubriker identifierades med följande tre underrubriker var. Huvudrubriken “en smärta som är ständigt närvarande” med medföljande underrubriker: “sår och psykiskt lidande”; “påverkan på dagliga livet” och “procedursmärta och smärtlindring vid såromläggning”. Den andra stora huvudrubriken, med efterföljande underrubriker var “sjuksköterskans roll i att identifiera lidande”. Här ingick underrubrikerna: “vikten av kontinuitet”, “kommunikationens betydelse” och “vårdens kunskap och följsamhet”. Slutsats Litteraturöversikten visade att faktorer relaterade till att leva med kroniska sår och omvårdnaden av dessa påverkar patientens välmående och lidande. Denna kunskap och förståelse kan även vara av gagn i arbetet med att främja hälsa och välbefinnande hos patienter med kroniska sår. Såromläggningen nyttjades inte fullt ut som ett naturligt patientmöte, därmed kunde inte sjuksköterskor eller annan vårdpersonal identifiera och lindra patientens dagliga lidande. / Background Chronic wounds may cause suffering and a loss of quality of life for patients. These wounds may also bring added costs in a greater social aspect. Chronic wounds are mainly found in an older patient group and may have their origin in different factors. Though the primary goal in health care is wound healing, patients find it is of equal or more importance to reduce the suffering that these wounds entail. There is however a lack of knowledge in healthcare how the needs of this patient group is best met. To describe how these patients experience their suffering may bring a better understanding of what factors are of importance in this group and thus lead to better knowledge for the health care personnel concerning suffering associated with chronic wounds. Aim The aim was to describe how the patients suffering was affected when caring for chronic wounds Method A non systematic review that included 17 original articles. Both qualitative and quantitative articles were included. The articles were found in the databases PubMed and CINAHL with use of index terms and manual searches. The included articles were reviewed for quality and analyzed with an integrated analysis. Results Two main headlines were identified, with three subcategories respectively. The first main headline: “a constant presence of pain” had three subcategories: “ wounds and psychological suffering”; “effect on daily life” and “ procedure pain and analgesia in wound care”. The other main category was: “the nurses role in identifying suffering”. The three accompanying subcategories were: “the impact of continuity”; “the importance of communication” and “the knowledge and flexibility of the healthcare personnel”. Conclusions The review study found that the factors of living with chronic wounds as well as the nursing care associated with the wound affected the patients health and suffering. This knowledge can therefore be of use to promote health and well being in patients with chronic wounds. The wound care procedure where not always fully used as a natural patient meeting which could bring difficulties for the nurse to identify and aid the patients daily suffering.

Bakgrund: Förekomsten av svårläkta sår i världen är hög. Kunskapen gällande hur det är att leva med svårläkta sår är bristfällig. Studien belyser den omfattande inverkan som svårläkta sår kan ha på den drabbade personens upplevda livskvalitet. Studien ger värdefull kunskap för vårdpersonal och beslutsfattare som arbetar med sårvård. Syfte: Syftet är att belysa erfarenheter av att leva med svårläkta sår. Metod: Studien är en allmän litteraturstudie baserad på åtta vetenskapliga artiklar. Kvalitativ innehållsanalys har använts som analysmetod av de inkluderade artiklarna. Resultat: Personer med svårläkta sår får ofta otillräcklig och inkonsekvent vård, vilket leder till bristande förtroende för vårdpersonal. Bristfällig kommunikation och dokumentation kan orsaka upplevelser av förvirring och maktlöshet för patienterna. Litteraturstudien resulterade i fyra kategorier som beskriver erfarenheter av att leva med kroniska sår: isolering och skam, smärta, sjukvård och livskvalitet. Konklusion: Personer med svårläkta sår känner ofta isolering, skam och smärta vilket påverkar livskvaliteten negativt. Vårdgivare bör ta hänsyn till emotionella och sociala utmaningar och informera patienter om smärtlindring och behandling. Vårdgivare bör även skräddarsy behandlingen och vården för att uppfylla varje patients specifika behov. Ytterligare forskning krävs för att förbättra vårdkvaliteten. / Background: The prevalence of hard-to-heal wounds worldwide is high. There is a lack of knowledge about what it is like to live with a hard-to-heal wound. This study highlights the extensive impact that hard-to-heal wounds can have on the affected person’s perceived quality of life. The study provides valuable knowledge for healthcare professionals and policy makers involved in wound care. Aim: To highlight experiences of living with difficult to heal wounds. Method: This study is a general literature review based on eight scientific articles. Qualitative content analysis has been used as a method of analysis of the included articles. Results: People with hard-to-heal wounds often receive inadequate and inconsistent care, leading to a lack of trust in healthcare professionals. Poor communication and documentation can cause confusion and powerlessness for patients. This study on chronic wounds identified four main themes: isolation and shame, pain, healthcare, and quality of life. Conclusion: People with difficult-to-heal wounds often feel isolation, shame and pain, which negatively affects the quality of life. Caregivers should consider emotional and social challenges and inform patients about pain relief and treatment. Researchers and health care providers should tailor treatment and care to meet specific needs and further develop research to improve the quality of care.

Yes / The prevalence of Type 2 diabetes mellitus (T2DM) is escalating globally. Patients suffer from multiple complications including the development of chronic wounds that can lead to amputation. These wounds are characterised by an inflammatory environment including elevated tumour necrosis factor alpha (TNF-α). Dermal fibroblasts (DF) are critical for effective wound healing, so we sought to establish whether there were any differences in DF cultured from T2DM donors or those without diabetes (ND-DF). ND- and T2DM-DF when cultured similarly in vitro secreted comparable concentrations of TNF-α. Functionally, pre-treatment with TNF-α reduced the proliferation of ND-DF and transiently altered ND-DF morphology; however, T2DM-DF were resistant to these TNF-α induced changes. In contrast, TNF-α inhibited ND- and T2DM-DF migration and matrix metalloprotease expression to the same degree, although T2DM-DF expressed significantly higher levels of tissue inhibitor of metalloproteases (TIMP)-2. Finally, TNF-α significantly increased the secretion of pro-inflammatory cytokines (including CCL2, CXCL1 and SERPINE1) in ND-DF, whilst this effect in T2DM-DF was blunted, presumably due to the tendency to higher baseline pro-inflammatory cytokine expression observed in this cell type. Collectively, these data demonstrate that T2DM-DF exhibit a selective loss of responsiveness to TNF-α, particularly regarding proliferative and secretory functions. This highlights important phenotypic changes in T2DM-DF that may explain the susceptibility to chronic wounds in these patients. / This study was funded by an Iraqi government studentship to AHAA-R.

Les maladies fébriles y compris les maladies bactériennes sont mal connues en Côte d’Ivoire et en Guinée. Tout d’abord, nous avons recherché par biologie moléculaire des bactéries pathogènes transmises par les tiques en Côte d’Ivoire. Nous avons analysé différentes espèces de tiques prélevées chez des bovins et mis en évidence des bactéries pathogènes responsables de nombreuses maladies infectieuses comme Rickettsia, Borrelia, Anaplasma, Ehrlichia, Coxiella burnetii (fièvre Q) et aussi vingt nouvelles espèces potentielles.Ensuite, notre objectif était de détecter par biologie moléculaire des micro-organismes pathogènes chez l’homme. Concernant l’étude des plaies et des peaux saines en Guinée, la plupart des patients étaient infectés par Pseudomonas aeruginosa, Staphylococcus aureus et plusieurs espèces d'Acinetobacter.Parmi les patients fébriles et les sujets apyrétiques recrutés en Guinée et en Côte d’Ivoire, Plasmodium falciparum reste le micro-organisme le plus fréquent surtout dans les échantillons de sang des patients fébriles bien que plusieurs bactéries aient été aussi identifiées. En Guinée, il s’agissait de Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Salmonella enterica Non Typhi et Non Paratyphi et R. felis. Ces bactéries ont été également identifiées ainsi que Salmonella enterica Typhi, Salmonella enterica Paratyphi, Tropheryma whipplei et une nouvelle espèce potentielle de Wolbachia en Côte d’Ivoire. Nos travaux ont permis d’établir le répertoire des bactéries transmises par les tiques en Côte d’Ivoire, celles impliquées dans les bactériémies en Côte d’Ivoire et en Guinée (Conakry). / Febrile illnesses including bacterial diseases are poorly known in Côte d'Ivoire and Guinea.In the first part of our work, we researched by molecular biology bacteria transmitted by ticks in Côte d’Ivoire. We analyzed different species of ticks collected from cattle and highlighted pathogenic bacteria responsible for many infectious diseases such as Rickettsia, Borrelia, Anaplasma, Ehrlichia, Coxiella burnetii (Q fever) and twenty potential new species. In the second part, our goal was to detect using molecular biology several microorganisms in humans in Guinea (Conakry) and Côte d'Ivoire. As regards the study of wounds and healthy skin in Guinea, most patients were infected with Pseudomonas aeruginosa, Staphylococcus aureus, several species of Acinetobacter.Among the febrile patients and healthy controls afebrile recruited in Guinea and Côte d'Ivoire, Plasmodium falciparum is the most common detected microorganism especially in blood samples from febrile patients although several bacteria were also identified. In Guinea, it was Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, non-typhoidal Salmonella spp., and R. felis. These bacteria were also identified as well as Salmonella enterica Typhi, Salmonella enterica Paratyphi, Tropheryma whipplei and a potential new species of Wolbachia in Côte d’Ivoire.This work allowed establishing the repertory of bacteria transmitted by ticks in Côte d’Ivoire, as well as those involved in bacteremia in Côte d’Ivoire and Guinea (Conakry).