Medical Sciences

Background/Objectives: Bromelain-based enzymatic debridement (NexoBrid^®) is an established tissue-preserving alternative to tangential excision in deep partial-thickness burns. Its clinical efficacy is supported by randomised trials, but its systemic effects are inconsistently described and its effects at tissue level in humans are largely unknown. The objective was to synthesise the human evidence on both domains and to determine, as a prespecified endpoint, whether any study has evaluated them in the same patients. Methods: PubMed, Embase and Scopus were searched between 2016 and 2026 using two stream-specific strategies that shared their intervention and population blocks and differed only in their outcome block: Stream A, clinical outcomes reported with systemic biological parameters; Stream B, clinical outcomes reported with histopathological findings. Eligible studies were original human investigations published in the last ten years. Risk of bias was assessed with ROBINS-I and the JBI checklists, and the synthesis was narrative, following PRISMA 2020 and SWiM. Results: Of 559 records, twelve studies were included: ten in Stream A (970 patients) and two in Stream B (nine patients); no study identified by the present search met the criteria of both. C-reactive protein and procalcitonin were significantly higher after enzymatic than after surgical debridement throughout the first week, and, in the single study that analysed the treated area as a continuous exposure, the probability of a post-debridement coagulation alteration rose with the area treated (odds ratio 1.158 per percentage point of body surface). Early fever occurred in 14% of patients and predicted later wound infection. Both histological studies were purely qualitative: neither reported a thickness, a percentage or a cell count, and neither reported any laboratory value. Conclusions: Enzymatic debridement is associated with a measurable systemic response whose proposed mechanisms are all statements about tissue that has never been examined. The two literature fields describe the same process at two levels of observation, in different patients and at incompatible times. No validated instrument exists for quantifying the human burn biopsy after debridement.

Background/Objectives: The 2024 WHO guidelines incorporated the APRI index into treatment decisions for chronic hepatitis B, with thresholds of >0.5 for significant fibrosis and >1.0 for cirrhosis, because it can be computed when neither biopsy nor elastography is available. The evidence supporting those thresholds derives almost entirely from studies using liver biopsy as reference standard; how serological indices behave when the available comparator is elastography remains unknown, and no data exist for Andean populations. We aimed to quantify the agreement of APRI and FIB-4 with transient elastography, determine whether either discriminates better, and evaluate the 2024 WHO thresholds in this setting. Methods: Retrospective agreement study of patients in the Hepatitis B Elimination Plan of Huanta, Peru. APRI and FIB-4, computed from routine laboratory results, were compared against transient elastography (FibroScan 402, M+ probe) used as a reference standard given the unavailability of biopsy. Outcomes followed the 2024 WHO thresholds: >7.0 kPa for significant fibrosis and >12.5 kPa for cirrhosis. Only examinations meeting the pre-specified quality criterion (at least 10 valid measurements; IQR/median ≤ 30%) were analyzed. Diagnostic properties were estimated with exact confidence intervals and likelihood ratios, areas under the curve with bootstrap intervals, and the between-index comparison with DeLong’s test for paired curves. Reporting followed STARD 2015. Results: Of 92 patients, 73 had a valid elastography examination; APRI was computable in 60 and FIB-4 in 57. Prevalence was 23.3% (95% CI 14.2–34.6) for significant fibrosis and 12.3% (5.8–22.1) for cirrhosis. For significant fibrosis, APRI > 0.5 achieved 61.5% sensitivity (31.6–86.1) and 74.5% specificity (59.7–86.1), with a positive likelihood ratio of 2.41 (1.26–4.62) and a negative one of 0.52 (0.25–1.05). For cirrhosis, APRI > 1.0 yielded 71.4% sensitivity, 92.5% specificity and a positive likelihood ratio of 9.46 (3.30–27.11). Areas under the curve were 0.844 and 0.808 for significant fibrosis and 0.914 and 0.874 for cirrhosis; DeLong’s test detected no statistically significant difference between indices at either level (p = 0.47 and 0.53); however, the limited number of outcome-positive cases (13 and 7, respectively) means that clinically important differences cannot be excluded and equivalence has not been established. Conclusions: APRI and FIB-4 identified cirrhosis with likelihood ratios large enough to act on but were only weakly informative at the threshold that governs treatment eligibility, where the negative likelihood ratios did not exclude unity. Neither index can be used as a stand-alone rule-out test at that threshold. The small number of outcome-positive cases limits precision throughout. Although the program intended both assessments to occur during the same session, individual dates were unavailable, preventing verification of the actual interval between elastography and blood sampling.

Background: Sickle cell disease (SCD) is a genetic disease where a mutation in beta-globin results in an increased hemoglobin S percentage (Hgb S%), which is responsible for the crisis. The aim of this study was to determine the impact of each unit packed red blood cell (PRBC) simple transfusion on complete blood count (CBC) and high-performance liquid chromatography (HPLC) parameters in adult patients with SCD. Methods: This prospective cohort study was conducted between 29 September 2024, and 30 July 2025, among n = 65 SCD patients requiring hospitalization in the hematology department for blood transfusions. Medication, frequency of admission, and demographic information were obtained from the health informatics system. In addition, CBC, white blood cell (WBC), hemoglobin (Hgb), platelet (Plt), and HPLC data were obtained within 24 h before and after the PRBC transfusion. Results: Of n = 65 SCD patients, 87.7% matched the SS phenotype; 58.5% were females; the mean age was 27.23 years. Blood group O+ accounted for 50.8% of the patients, followed by A+ (33.8%). The mean Hgb values before and after transfusion were 7.16 (standard deviation (SD) 0.82) and 8.67 (SD 0.96), respectively (p < 0.001). The mean Hgb S% values before and after transfusion were 71.25 (SD12.19) and 55.97 (SD11.24), respectively (p < 0.001). The difference in the mean values of WBC, Hgb F% and Hgb A% (p < 0.001), as well as Hgb A2% (p = 0.006), changed significantly before and after blood transfusion. A negative correlation between body mass index (BMI) and changes in Plt count was found (p = 0.009). Conclusions: This study quantified the impact of each PRBC unit on CBC and HPLC parameters. While these findings may support strategies to reduce alloimmunization, this outcome was not evaluated and requires further study.