Management, as well as prevention, of wound infection is key in the promotion of the healing process. In India, over one million people are moderately or severely burnt every year, and managing the challenging burn wounds is a daily reality for clinicians in the country. Silver has been used as an antimicrobial in burn wound management for decades and modern advanced dressings can provide safe prevention and management of infection in these cases. This article reports the cases of two adults, an infant and a child with burns, at risk of infection and managed with a Technology Lipido-Colloid non-adherent dressing with silver (TLC-Ag; UrgoTul Ag/Silver). The main benefits observed when using the evaluated dressing in these patients included rapid wound healing but also patient-related outcomes, such as decrease in pain and atraumatic removal.

Dr Venkateswaran

Plastic Surgeon, Jupiter Hospital, Mumbai, India

Dr Ravichander Rao A

Plastic Surgeon, Care Hospital, Hyderabad, India

Dr Krishna Kumar

Plastic, Aesthetics, Burns, Hand and Reconstructive Microsurgeon, Kovai Medical Centre & Hospital, Coimbatore, India

Dr Sankamithra

Consultant Plastic Surgeon, Lakshmi Medical center, Pollachi, India

Key words

• Burns
• Lipido-colloid non-adherent dressing

• Silver

Declarations

All authors have no particular conflicts of interest to declare regarding these cases.

Abstract: Electrical burns represent 5-8% of burns in developed countries (World Heath Organization, 2016). A multidisciplinary approach is required due to the variety and complexity of injuries, which are affected by the intensity of the electrical current, compromised tissues in the patient, and the duration of exposure. This paper presents a patient case and discusses complications to consider. The efficacy, tolerability and safety of recombinant human epidermal growth factor (rhEGF) is discussed together with other considerations and long-term outcomes.

Espitaleta Omaira

Department of Plastic and Reconstructive Surgery, Clínica Cartagena del Mar S.A.S.

Dr Román Carlos

Plastic Surgeon, Clínica General del Caribe

Gaviria N. Ángela María

BSc, MSc Epidemiology, Grupo Biociencias, Institución Universitaria Colegio Mayor de Antioquia

Carrillo B. Carlos Alberto

Epidemiologist, Sociedad Colombiana de Medicina Preventiva

Key words

• Electricai burns
• rhEGF
• Multidisciplinary

Samina Ali

      In the UK, people with type 1 diabetes and those with type 2 diabetes managed with multiple daily insulin injections (MDI) meet the eligibility criteria for continuous glucose monitoring (CGM) use. Previous studies have shown that CGM results in improvements in diabetes distress and HbA1c in people with type 2 diabetes on MDI; however, studies in people with type 2 diabetes on pre-mixed insulin regimens have not been published to date. This service evaluation of ten people with type 2 diabetes on twice-daily pre-mixed insulin regimens using the FreeStyle Libre 2 CGM system demonstrates improvements in both diabetes distress scores and HbA1c. Although only a small study, the findings suggest that expanding CGM eligibility criteria to include this patient group may be beneficial.

Citation:  Ali S (2024) Impact of Freestyle Libre 2 on diabetes distress and glycaemic control in people on twice-daily pre-mixed insulin. Diabetes & Primary Care 26 : [ Early view publication]

Article points

1. There are limited studies on the use of continuous glucose monitoring (CGM) in people with type 2 diabetes on twice-daily pre-mixed insulin regimens.

2. In this small service evaluation, CGM use was associated with reductions in PAID (Problem Areas In Diabetes) scores of diabetes distress and in HbA1c.

3. Local and national guidelines may need to be amended to include twice-daily pre-mixed insulin in the eligibility criteria for CGM use in people with type 2 diabetes.

Key words

– Continuous glucose monitoring

– Insulin

– Pre-mixed insulin

– Type 2 diabetes

Author

Samina Ali, Advanced Practice Pharmacist, NHS Greater Glasgow and Clyde.

The Fibrosis-4 index (Fib-4) can be used not only as a diagnostic tool for assessing advanced fibrosis in those with or at risk of developing non-alcoholic fatty liver disease, but also as a pragmatic biomarker to help assess the risk of liver and cardiovascular events and mortality over time, according to this large, prospective, longitudinal cohort study published in The Lancet Regional Health – Europe. The associations between Fib-4 and risk of liver events, cardiovascular events and all-cause mortality were independent of cardiovascular risk at study baseline, and an increase or decrease in Fib-4 score over 12 months was correlated with increased and decreased risk, respectively, across all three event types. Although hazard ratios for liver and cardiovascular events and mortality over time were initially higher in the indeterminate-risk group (Fib-4 score of 1.3–2.67) compared to the low-risk group (Fib-4 <1.3), they were no longer significant after adjustments for age, sex and baseline Framingham risk score. However, the hazard ratios for all three outcomes remained significantly elevated in those with a Fib-4 score of >2.67 (i.e. those with a high risk of advanced fibrosis) even after these adjustments. The authors conclude that sequential Fib-4 testing should be part of ongoing care in people with obesity and/or type 2 diabetes, as well as being used as a diagnostic marker for risk of advanced liver fibrosis to prompt referral for further testing.

Pam Brown GP in Swansea

Citation: Brown P (2024) Diabetes Distilled: Fib-4 – A diagnostic and prognostic marker for liver and cardiovascular events and mortality. Diabetes & Primary Care 26: [Early view publication]