Active Ulcer Research Articles

Prevalence and Predicting Factors of Combined Iliocaval Venous Obstruction and Superficial Venous Reflux in Patients with Healed and Active Venous Leg Ulcer

Prevalence and Predicting Factors of Combined Iliocaval Venous Obstruction and Superficial Venous Reflux in Patients with Healed and Active Venous Leg Ulcer

First pilot case-control interventional study using autologous extracellular vesicles to treat chronic venous ulcers unresponsive to conventional treatments

Current therapeutic approaches for chronic venous ulcers (CVUs) still require evidence of effectiveness. Diverse sources of extracellular vesicles (EVs) have been proposed for tissue regeneration, however the lack of potency tests, to predict in-vivo effectiveness, and a reliable scalability have delayed their clinical application. This study aimed to investigate whether autologous serum-derived EVs (s-EVs), recovered from patients with CVUs, may be a proper therapeutic approach to improve the healing process. A pilot case-control interventional study (CS2/1095/0090491) has been designed and s-EVs recovered from patients. Patient eligibility included two or more distinct chronic lesions in the same limb with 11 months as median persistence of active ulcer before enrollment. Patients were treated three times a week, for 2 weeks. Qualitative CVU analysis demonstrated that s-EVs-treated lesions displayed a higher percentage of granulation tissue compared to the control group (Sham) (s-EVs 3 out of 5: 75–100 % vs Sham: none), further confirmed at day 30. s-EVs-treated lesions also displayed higher sloughy tissue reduction at the end of treatment even increased at day 30. Additionally, s-EV treatment led to a median surface reduction of 151 mm2 compared to 84 mm2 in the Sham group, difference even more evident at day 30 (s-EVs 385 mm2vs Sham 106 mm2p = 0.004). Consistent with the enrichment of transforming growth factor-β1 in s-EVs, histological analyses showed a regenerative tissue with an increase in microvascular proliferation areas. This study first demonstrates the clinical effectiveness of autologous s-EVs in promoting the healing process of CVUs unresponsive to conventional treatments.

COMPARISON OF ENDOVASCULAR AND STRIPPING METHODS IN COMBINATION WITH PROLONGED INTRAVENOUS INFUSION THERAPY OF LIDOCAINE IN TREATMENT OF CHRONIC VENOUS INSUFFICIENCY

The aim of the work: to compare the results of using endovascular and classical stripping methods in combination with intravenous administration of lidocaine solution for the treatment of chronic venous disease in the stage of trophic wounds. Materials and Мethods. The results of treatment of 78 patients with chronic venous insufficiency in stage C6 and C6r were evaluated. Subjects were divided into two clinical groups: group 1 - endovenous laser ablation (n=31) and group 2 (n=47) – classical surgical intervention (high ligation + great saphein vein stripping). In both groups method of prolonged intravenous lidocaine 2 % solution injection was used according to the proposed method. Postoperative monitoring was performed 1, 3, 6 months and 1 year after the surgical treatment. The result was evaluated when compared with the VCSS, VDS, VSDS scales. Results and Discussion. The dynamics of the pain syndrome when evaluated after 1, 3, 6 months generally showed its rapid regression among patients of both groups. In both experimental groups, the average value of the "number of active ulcers" before surgical treatment was (1.89 ± 0.06) points in the prospective group and (1.92 ± 0.08) points in the retrospective group, respectively, which indicated the presence of an average almost 2 active ulcers in one patient. After the treatment in group 1, rapid dynamics of healing of the wound surfaces was observed already after 1-3 months of postoperative treatment. While in group 2, after 6 months, somewhat slower dynamics were observed. In the same group, a year after treatment, the presence of recurrence of active trophic ulcers was noted in 10 % of patients.It was established that the combination of minimally invasive methods of treatment of varicose veins with endovenous laser coagulation in combination with prolonged administration of lidocaine solution significantly accelerates the healing of trophic wounds. At the same time, analyzing the indicators of the VCSS, VDS, VSDS scales, significantly better clinical indicators were established in terms of follow-up up to 1 year.

Minimal vessel area predicts in-stent restenosis in nonthrombotic iliac vein compression syndrome after stenting.

Minimal vessel area predicts in-stent restenosis in nonthrombotic iliac vein compression syndrome after stenting.

Prevalence and predictors of combined >50% iliocaval venous obstruction and superficial venous reflux in chronic venous insufficiency patients with healed or active venous leg ulcer

ObjectiveThe aim of the present study was to investigate the prevalence and predictors of combined >50% iliocaval venous obstruction (ICVO) and superficial venous reflux (SVR) in patients with chronic venous insufficiency (CVI) with a healed (C5) or an active (C6) venous leg ulcer (VLU). MethodsWe conducted a retrospective review of prospectively collected data from patients with CVI with CEAP (Clinical, Etiology, Anatomy, Pathophysiology) class C5 (healed ulcer) or C6 (active ulcer) with SVR who had been treated at our institution from February 2017 to January 2018. The demographic, clinical, and surgical data and duplex ultrasound and computed tomography venography findings were collected. We used OsiriX MD, version 2.9, software (Pixmeo SARL, Bernex, Switzerland) to measure the vein diameter via multiplanar reconstruction. The prevalence of combined >50% ICVO and SVR was evaluated, and univariate and multivariate analyses were performed to identify the independent predictors of >50% ICVO in patients with CVI and SVR. ResultsA total of 79 limbs from 67 patients were enrolled. The mean age was 59.82 ± 12.86 years, the mean body mass index was 28.68 ± 6.41 kg/m2, and 41.8% were men. The prevalence of >50% ICVO in the patients with SVR was 31.6%. Univariate analysis showed a history of deep vein thrombosis (DVT) in the affected leg (P = .001), a VLU in the left leg (P = .033), a history of a recurrent VLU (P = .038), and reversed flow in the superficial epigastric vein (P = .004) were significantly associated with >50% ICVO in patients with CVI and SVR. Multivariate analysis revealed a history of DVT in the affected leg (adjusted odds ratio [aOR], 8.31; 95% confidence interval [CI], 2.29-30.19; P = .001), a VLU in the left leg (aOR, 3.95; 95% CI, 1.18-13.19; P = .026), and a history of a recurrent VLU (aOR, 3.08; 95% CI, 1.02-9.32; P = .047) to be independently associated with combined >50% ICVO and SVR in patients with CVI. ConclusionsThe prevalence of combined >50% ICVO and SVR in patients with CVI and CEAP C5 or C6 was 31.6%. The independent predictors of combined >50% ICVO and SVR in those with CVI were a history of DVT in the affected leg, a VLU in the left leg, and recurrent VLUs.

P388 Shear wave elastography predicts short-term response to induction therapy in patients with Crohn’s disease

Abstract Background Endoscopy has been used to assess the disease activity of Crohn's disease (CD) but may not be sufficient considering the transmural nature of its inflammation. Bowel ultrasonography (BUS) has been reported to reflect disease activity of CD and long-term outcomes. We performed a prospective study to determine whether BUS can predict short-term clinical response to induction therapy. Methods Consecutive CD patients with active ulcers in endoscopy requiring induction therapy (Anti-TNF antibody, IL-12/23 p40 antibody, integrin inhibitor, prednisolone) were prospectively enrolled at a single center from October 2018 to July 2022. Short-term clinical response was defined by a reduction of Crohn’s disease activity index > 70 at week 8. Ultrasonographic findings (bowel wall thickness (BWT), colour Doppler signal (CDS), and shear wave elastography (SWE) were recorded for the most severely affected segment at baseline, week 1, and 8 and compared between responders and non-responders. Results Seventeen out of 29 patients were classified as responders at week 8. There was no difference in BWT and CDS at baseline, week 1, and 8 between responders and non-responders (Table 1). In contrast, responders had lower baseline SWE compared with non-responders (2.7±0.3 vs. 3.8±0.3, p=0.02). Adjusted by the prior exposure to biologics, the lower SWE at baseline was associated with clinical response at week 8 (adjusted odds ratio associated with 0.1 m/s increase: 0.9, p=0.018) (Table 2). SWE did not change over time regardless of response for 8 weeks. Conclusion Lower intestinal wall stiffness as measured by SWE is an independent predictor of short-term clinical response.

Prevalence and Risk Factors of GERD among Stable COPD Patients

Introduction: Gastroesophageal reflux disease (GERD) is one of the most common causes of a chronic cough and is a potential risk factor for chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to determine the prevalence of GERD in COPD patients. Methods: This was a cross-sectional study involving 40 stable COPD patients recruited from outpatient asthma and COPD clinics at Persahabatan National Respiratory Referral Hospital, Jakarta, from May to November 2018. COPD was defined as having a ratio of post-bronchodilator FEV1/FVC < 0.7 and no abnormality on a chest X-ray except emphysematous. Diagnosis of GERD was based on oesophageal mucosal lining break surrounding the distal esophageal sphincter through esophagogastroduodenoscopy (EGD). Asthma patients with known esophageal diseases such as cancer, achalasia, and active peptic ulcer and patients who had used proton pump inhibitors in the last 15 days were excluded. Results: Patients were divided into GERD (+) (16/40, 40%) and GERD (-) (24/40, 60%). Subjects were predominantly elderly (25/40, 62.5%) and had a smoking history (36/40, 90%). Exacerbation and COPD assessment test (CAT) score was significantly associated with GERD (p < 0.05). No significant difference regarding age, sex, Brinkman Index, lung function, and body mass index (BMI) was found between groups. However, the GERD (+) group showed a slightly higher BMI and more severe airflow obstruction. Conclusion: The prevalence of GERD in COPD patients found in this study was as high as 40%. A cohort study and preventive strategy of GERD in COPD should be studied further.

Creating a Patient Registry for the Parkview Vein Clinic

Background/Objective: The Parkview Vein Clinic provides individualized care to patientssuffering from venous disease by providing assessment, education, treatment, ultrasound imaging, and surgical interventions all under one roof. The Vein Clinic has experienced a consistent increase in patient volume since opening in 2019, creating a need for tracking patient outcomes. Patient registries are useful tools for tracking high volumes of patients, assessing outcomes, and improving treatment guidelines. The main objective of this quality improvementproject is to define the workflow for creating a patient registry for the Vein Clinic and determine which data points are feasible to collect.
 Methods: This is a retrospective chart review of patients with the diagnosis of “venous stasis ulcer” seen at the Vein Clinic from September 2019 to July 2022. A total of 84 data fields were collected on each patient, including information on demographics, medical history, ulcer descriptions, imaging, procedure information, and post-procedure follow-up. The Society for Venous Surgery Vascular Quality Initiative was used as a template for registry design, with the goal of merging the registry with the national database in the future.
 Results: Venous ulcer information, including number of healed ulcers, duration of ulcer, and largest diameter active ulcer, was not readily accessible within the chart and required expanded review find and quantify. All other categories were readily accessible in the chart.
 Conclusions: The data collected by the registry will be useful for future quality improvement purposes of the Vein Clinic. Creation of a structured reporting template in Epic would help facilitate the ease and accuracy of data extraction and help maintain the internal validity of the registry. More detailed follow-up assessments should be implemented to track patient outcomes, which could include use of the Venous Clinical Severity Score or a patient-reported outcomes assessment.

Effect of Offloading Plantar Pressure on Peak Pressure in Ten Plantar Regions and Gait Speed in Men With Diabetes and Active Diabetic Foot Ulcers, and Healthy Men

Background and Aims Diabetes is associated with dysfunction and damage in various organs due to abnormal pressure on ten plantar regions. This study aims to compare the effect of offloading plantar pressure on peak pressure of ten plantar regions and gait speed in men with diabetes and active diabetic foot ulcers, and healthy men. Methods This is a causal-comparative study. Participants were 30 healthy men, 30 diabetic men and 30 men with active diabetic foot ulcers who needed no leg amputation according to their physicians. Sampling was done using random and convenience methods. Diabetic foot ulcers were classified based on the Meggitt-Wagner classification criteria, according to which grade 1 indicates grade 1 indicates a superficial ulcer and was used as a criterion for selecting people with diabetic foot ulcers. Plantar pressure variables were recorded using RSscan software (RSscan International, Belgium; 0.5×0.5×0.02 m, 4363 sensors) at a sampling frequency of 300 Hz and the gait speed was measured using a digital stopwatch. Correct walking considered as the full impact of the foot on the middle of the foot scan machine. Data were analyzed using independent t-test in SPSS software, version 24. Results The peak pressure in the metatarsal 3 (P<0.001), metatarsal 4 (P= 0.020), medial heel (P= 0.004) and lateral heel (P= 0.007) in the diabetic foot ulcer group significantly increased compared to the diabetic group. In addition, the peak pressure in the medial heel (P= 0.013) and lateral heel (P= 0.019) in the diabetic group significantly decreased compared to the healthy group. Conclusion Men with diabetic foot ulcers are more exposed to abnormal peak pressures in different plantar regions, which can cause irreversible clinical injuries. Diabetic men have a lower gait speed than healthy men which can be important in their rehabilitation.

Intravenous metronidazole-, levofloxacin-containing triple therapy for treating patients with Helicobacter pylori-related active peptic ulcer complications: A pilot study.

The aim of this pilot study was to evaluate the efficacy and safety of intravenous use esomeprazole, metronidazole, and/or levofloxacin in the treatment of Helicobacter pylori (H.pylori)-associated peptic ulcer complications. Inpatients with peptic ulcer complications who were not able to take oral medicine were randomly assigned to three groups: triple therapy (esomeprazole, levofloxacin, metronidazole) and dual therapy (esomeprazole, levofloxacin/metronidazole) for 7 days. After intravenous treatment, all patients received open-label oral esomeprazole 20 mg bid for another 1 month. All subjects were followed up for gastroscopy at the seventh day of intravenous treatment to confirm the ulcer healing and 13 C-urea breath test to confirm successful H.pylori eradication 4-6 weeks after completion of oral esomeprazole therapy. The H.pylori eradication rate of both LEV-dual therapy (33.3%, 95% CI: 9.7%-70.0%) and MTZ-dual therapy (50%, 95% CI: 21.5%-78.5%) was significantly lower than that of triple therapy (95%, 95% CI: 71.1%-97.4%) (p=.003, .016). There were no significant differences in the adverse effects among all treatment groups, and the adverse effects were rare. The intravenous triple regimen, consisting of proton-pump inhibitor, metronidazole, and levofloxacin, could be considered in patients of H.pylori-associated peptic ulcer complications if oral medicine cannot be provided.

Contemporary Multimodal Surgical Therapy Allows for Durable Healing of Venous Stasis Ulceration

Chronic venous disease has a high prevalence in the United States, with 1% to 1.5% of the population estimated to have healed or active ulcers. Surgical therapy often involves a variety of procedures aimed at treating underlying superficial and deep venous pathology. We sought to evaluate the effects of a contemporary, multimodal approach to surgical therapy of advanced venous disease.

Combined Charcot hindfoot and midfoot reconstruction using internal fixation method-surgical technique and single surgeon series.

Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third of Charcot deformities that require surgical limb salvage present with the involvement of midfoot and hindfoot. Surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique and technically challenging. We present the surgical technique of deformity correction and stabilisation using internal fixation, developed by the senior author (VK), and present the outcomes. All patients that had undergone combined hindfoot and midfoot reconstruction to address a limb threatening deformity due to Charcot neuroarthropathy, performed by the senior author, with a minimum follow-up of 12 months, have been included in this study. The principles of surgical reconstruction included adequate pre-operative optimisation of the patient, sequential deformity correction and stabilisation of the hindfoot followed by midfoot using the principle of long-segment rigid internal fixation with optimal bone opposition. Standard post-operative regime, including offloading, has been used in all patients. A total of 34 patients (35 feet) had undergone combined midfoot and hindfoot Charcot reconstruction between January 2009 and December 2019. Active ulcers were noted in 13 feet at the time of the procedure. Eleven reconstructions were performed as two-stage procedures due to the presence of active infection. At a mean follow-up of 53 months, 11/13 ulcer healed, and 32 patients (33 feet) were full weightbearing in surgical shoes or a brace at the latest follow-up. Bone fusion was noted in 28 feet in the hindfoot region and 32 feet in the midfoot. Metal work failure was noted in 5 feet requiring removal in 3 feet. Revision procedures were required in 4 patients. Our newly described technique of combined hindfoot and midfoot Charcot has provided functional limb salvage in majority of presentations, with an acceptable level of complications, at a medium-term follow-up of 53 months.

ЭПИДЕМИОЛОГИЯ И ФАКТОРЫ РИСКА ВАРИКОЗНОЙ БОЛЕЗНИ В ТАДЖИКИСТАНЕ

Objective: To analyze the prevalence of varicose vein disease (VVD) and its risk factors (RFs) among the population of Tajikistan in the pilot project involving the two regions of the country. Methods: From the general population permanently residing in D. Balkhi and Dusti districts of the Republic of Tajikistan 3,084 people were screened for VVD and its RFs, including 1,521 from the Dusti district (376 men and 1,145 women), and 1,563 from the D. Balkhi district (352 men and 1211 women). There were 728 men (23.6%), and 2,356 women (76.4%) enrolled in the study. The age of the screened cohort ranged from 11 to 83 years, with a mean age of 41.1±3.5 years. The study included analysis of complaints and anamnesis of the disease, a detailed study and identification of all possible RFs, angiological examination of the participants in order to identify the signs of VVC, as well as Doppler ultrasound examination (DUE) in case of dilatation of the main subcutaneous veins. Results: Clinical signs of VVD were detected in 1,469 (47.6%) people of the examined cohort, which were significantly less common in men (280 cases, 38.5%) than in women (1,189; 50.5%) (p<0.001). The most common manifestations were reticular varices and telangiectases (59.6%) with significantly higher frequency in females (p<0.001). The share of C2-C6 classes of VVC was 40.4% of cases, including decompensated forms of the disease with symptoms of induration, healed or active ulcers, which occurred in 4.9% of cases. Most often different forms of VVD were found in females (n=1189;80.9%) compared to males (n=280; 19.1%) (p<0.001). However, among male patients mild forms of VVD, such as reticular varices and telangiectases, were significantly less common (48.9%) compared to the females (62.2%; p<0.001). The main subcutaneous veins’ dilation and complicated forms of VVD (C2-C6) were observed in 51.1% of men and 37.8% of women, the difference between them being significant (p<0.001). Most commonly VVD was seen in the age of 31-40 and 41-50 years (83.2% and 69.7%, respectively). Significant RFs for VVD among the examined cohort were hereditary predisposition (OR 2.322; 95% CI: 1.247-3.421), pregnancy and number of deliveries (OR 3.041; 95% CI: 1.033-4.051), obesity (OR 1.338; 95% CI: 0.838- 2.481), regular static activity (OR 11.262; 95% CI: 7.452-17.019), prolonged standing or sedentary work (OR 3.627; 95% CI: 1.464-4.848), age over 18 years (OR 1.506; 95% CI: 0.839-2.702) and a combination of RFs (OR 8.096; 95% CI: 6.072-12.129). Conclusion: Almost half (47.6%) of the surveyed population suffers from VVD of varying severity, most of patients are young and middle-aged people, mainly women. Significant RFs for VVD among the examined cohort were hereditary predisposition, pregnancy and childbirths, obesity, regular heavy physical activity, prolonged sedentary or standing work, age, as well as a combination of these factors. Keywords: Chronic venous disease, varicose veins, epidemiology, risk factors.

Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care.

Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients' knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway's main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.

Salivary cortisol and alpha amylase enzyme levels in different phases of minor recurrent aphthous stomatitis

Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and stress is one of the major factors implicated in its causation. The aim of the present work is to measure the stress biomarkers, salivary cortisol (SC) and salivary alpha amylase (SAA), in the different phases of RAS. Patients and Methods: The study included 69 subjects of whom 38 patients served as the study group who suffered from minor RAS and one to three active minor oral ulcers of <48 h duration. The remaining 31 healthy subjects served as controls. Unstimulated salivary samples were collected twice from the study group; during the ulcerative phase of RAS and after complete healing has occurred, and only once from the controls. Concentrations of SC, and SAA enzyme were assessed by Enzyme-linked Immunosorbent Assay (ELISA). Results: There was a significant increase of SC and SAA in both the ulcerative and the post-healing phases in comparison to the control group. The ulcerative phase had higher but insignificant levels of both biomarkers when compared to the post-healing phase. There was a significant correlation between both biomarkers in the post-healing but not in the ulcerative phase. Conclusion: RAS patients have significantly higher levels of both stress biomarkers (SC and SAA) in the ulcerative and in the post-healing phases when compared to controls.

The pressure time integral: An underused, clinically significant parameter as a determinant of neuropathic ulceration in diabetes

BackgroundThe purpose of this study was to evaluate plantar pressure dynamics in the occurrence of active diabetic neuropathic ulceration (DNU) and any changes in loadings occurring in individuals with a history of diabetic neuropathic ulceration (DHNU). Since current gold standard offloading strategies are not producing desirable healing outcomes and optimum ulcer prevention, this study aimed to better understand the effect of diabetic peripheral neuropathy (DPN) and ulceration on mean peak plantar pressure (MPPP) and pressure-time integral (PTI) changes. Research questionIs there a redistribution of plantar pressure during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, in which, eighty adult participants were divided into four groups, namely, the DM, DPN, DNU and DHNU groups. Participants were instructed to walk barefoot over a Tekscan HR Mat™ at self-selected speed. MPPP and PTI data were analysed under five forefoot anatomical landmarks and compared between individuals with and without active neuropathic ulceration. ResultsMinimal MPPP significant changes were observed between ulcerated and non-ulcerated groups, however, PTI values were significantly increased in the ulcerated groups under all plantar ulceration regions. No significant plantar pressure differences were observed between the DNU and DHNU groups. Logistic regression tests demonstrated that as PTIs under the hallux increase, the likelihood of an individual living with DPN developing ulceration increases. SignificanceA significant increase in PTI values in the presence of ulceration highlights the importance of evaluating the duration of loads under forefoot regions during gait rather than just focusing on the magnitude of pressures during ulcer management and prevention. Moreover, results show that PTI values remain high in the presence of a history of neuropathic ulceration, possibly demonstrating the value of PTI as a clinical tool over MPPP in the assessment of the high-risk diabetic foot.

Exhaled Hydrogen after Lactulose Hydrogen Breath Test in Patient with Duodenal Ulcer Disease-A Pilot Study for Helicobacter-pylori-Associated Gastroduodenal Disease.

The precipitating mechanism(s) from the inactive to the active stage of duodenal ulcer disease (DU) is unclear. It has been shown that hydrogen gas from colonic fermentation provides an important energy source for Helicobacter pylori (Hp) colonization. The lactulose hydrogen breath test (LHBT) is a useful tool to assess the small intestinal and/or colon fermentation. This study examines the association(s) between the status of gastroduodenal disease and the result of a lactulose hydrogen breath test (LHBT). We enrolled Hp-positive active duodenal ulcer (aDU) patients, inactive DU (iDU) patients and patients with a positive Hp infection without structural gastroduodenal lesion, i.e., simple gastritis (SG Hp+). The patients with simple gastritis without Hp infection (SG Hp-) served as controls. Histological examinations of the gastric mucosa and lactulose hydrogen breath test (LHBT) were performed. SG Hp+ patients tend to have advanced gastritis (pangastritis or corpus-predominant gastritis) compared with SG Hp- patients (7/29 vs. 0/14, p = 0.08). More iDU patients had advanced gastritis than either the SG Hp+ (7/9 vs. 7/29, p = 0.006) or aDU patients (7/9 vs. 6/24, p = 0.013). In comparison with the aDU patients, the iDU patients were also older (52.1 ± 12.6 vs. 42.2 ± 11.9 years, p = 0.02) and had a lower mean area under the curve value of the LHBT(AUC) (209.1 ± 86.0 vs. 421.9 ± 70.9, p = 0.023). aDU patients with a positive Hp infection have a lower grade of gastric mucosa damage than iDU patients and tend to have a higher level of exhaled hydrogen after LHBT.

Extending brainstem and capsule-thalamic lesions in a patient with parenchymal neuro-Behçet disease

AbstractA 44-year-old female patient with a history of recurrent oral and genital ulcers presented with rapid gait disturbance, headaches, dysphonia, dysphagia, and diplopia evolving for 3 weeks. On examination, spastic tetraparesis, cerebellar ataxia, and nerves palsies were noted. Pseudofolliculitis of the lower limbs and active buccal ulcers were identified. Cerebral MRI demonstrated T2-Flair hyperintense capsulothalamic lesion with midbrain and latero-protuberantial extension. The international criteria for the diagnosis of definite Neuro-Behçet’s disease (NBD) were met in our patient. Evolution under cyclophosphamide and intravenous methylprednisolone was favorable. The radiological findings in NBD are broad and challenging. Clinicians should be particularly suspicious of NBD in brain MRI with extensive lesions, involving the brainstem.

Gender differences in juvenile systemic sclerosis patients: Results from the international juvenile scleroderma inception cohort.

To compare organ involvement and disease severity between male and female patients with juvenile onset systemic sclerosis. Demographics, organ involvement, laboratory evaluation, patient-reported outcomes and physician assessment variables were compared between male and female juvenile onset systemic sclerosis patients enrolled in the prospective international juvenile systemic sclerosis cohort at their baseline visit and after 12 months. One hundred and seventy-five juvenile onset systemic sclerosis patients were evaluated, 142 females and 33 males. Race, age of onset, disease duration, and disease subtypes (70% diffuse cutaneous) were similar between males and females. Active digital ulceration, very low body mass index, and tendon friction rubs were significantly more frequent in males. Physician global assessment of disease severity and digital ulcer activity was significantly higher in males. Composite pulmonary involvement was also more frequent in males, though not statistically significantly. After 12 months, they are the pattern of differences changed female patients had significantly more frequent pulmonary involvement. In this cohort, juvenile onset systemic sclerosis had a more severe course in males at baseline and but the pattern changed after 12 months. Some differences from adult findings persisted, there is no increased signal of pulmonary arterial hypertension or heart failure in male pediatric patients. While monitoring protocols of organ involvement in juvenile onset systemic sclerosis need to be identical for males and females.

Formulation Development and Evaluation of Oro-Dispersible Tablets Based On Solid Dispersion of Cimetidine

The most common problem about conventional dosage form is dysphagia (difficulty in swallowing). So, we design a new approach in a conventional dosage form which is oral dispersible tablet. Oral dispersible tablet is also called as mouth dissolving tablet, fast dissolving tablet, or oral disintegrating tablet. Oral dispersible tablet has advantage as it quickly disintegrates into saliva when it is put on the tongue. The faster the drug disintegrates or is dissolved, the faster the absorption and the quicker the therapeutic effect of drug will be attained. The objective of present study was to formulate directly compressible orodispersible tablets of cimetidine with improved solubility and bioavailability by using solid dispersion technique. Cimetidine is a histamine H2-receptor antagonist. It is widely prescribed in active duodenal ulcers, gastric ulcers, Zollinger-Ellison syndrome, gastroesophageal reflux disease and erosive esophagitis. Solid dispersion of cimetidine was prepared by anti-solvent addition method and physical mixture using novel polymer eudragit E 100. Saturation solubility of drug was determined in physical mixture and solid dispersion formulation. The prepared solid dispersion formulations were further characterized by drug contents, HPLC, and encapsulation efficiency. Orodispersible tablets of cimetidine were prepared by direct compression method and blend was evaluated for the pre-compression parameters such as bulk density, compressibility, angle of repose etc. The tablets were prepared by using selected solid dispersion formulation and excipients with sodium starch glycolate as a superdisintegrant and evaluated for hardness, friability, weight variation, content uniformity, wetting time, dispersion time and in-vitro drug release. Orodispersible tablet shows wetting time 27±1 seconds and in-vitro drug release 93.20±3.181%, which is better as compare to tablet containing pure drug (82.36±1.986) within 20min. Thus formulation of orodispersible tablet of cimetidine solid dispersion showed increased solubility and bioavailability with patient complies and convenience.
 Keywords: Cimetidine, Orodispersible tablets, Solid dispersion, Anti solvent addition method, Superdisintegrant