Diabetic Wound Care Research Articles

Fabrication of dual drug-loaded polycaprolactone-gelatin composite nanofibers for full thickness diabetic wound healing.

Aim: Design of moxifloxacin and ornidazole co-loaded polycaprolactone and gelatin nanofiber dressing for diabetic wounds. Materials & methods: The composite nanofibers were prepared using electrospinning technique and characterized for in vitro drug release, antibacterial activity, laser doppler and in vivo wound healing. Results: The optimized nanofiber demonstrated an interconnected bead free nanofiber with average diameter <200nm. The invitro drug release & antimicrobial studies revealed that optimized nanofiber provided drug release for >120h, thereby inhibiting growth of Escherichiacoli and Stapyhlococcusaureus. An in vivo wound closure study on diabetic rats found that optimized nanofiber group had a significantly higher wound closure rate than marketed formulation. Conclusion: The nanofiber provided prolonged drug release and accelerated wound healing, making it a promising candidate for diabetic wound care.

The Effect of Low-Temperature Microwave Plasma on Wound Regeneration in Diabetic Rats

Impaired wound healing in diabetic individuals presents a significant clinical challenge, and this study explores the impact of low-temperature microwave plasma in an argon atmosphere, a type of cold atmospheric plasma (CAP), on wound regeneration in diabetic rats. The findings reveal that this CAP treatment accelerates wound regeneration in diabetic rats, promoting faster wound closure, reducing inflammation, and enhancing critical regenerative processes such as angiogenesis, collagen synthesis, and extracellular matrix remodeling. Additionally, CAP exhibits anti-inflammatory effects by modulating the immune response towards a pro-regenerative state. These results underscore the potential of CAP in diabetic wound care, offering a promising approach to address delayed wound healing in diabetic patients and potentially improving the quality of life for those with chronic diabetic wounds.

Nociceptive and Transcriptomic Responses in a Swine Diabetic Wound Model Treated With a Topical Angiotensin 1 Receptor Antagonist.

Painful, treatment-resistant wounds are prevalent among diabetic patients and significantly affect health-related quality of life (HRQOL). Topical treatments may help alleviate pain without risk of dependence or side effects. However, there is a lack of topical wound compounds targeting pain-specific receptors. One possible target is proinflammatory angiotensin 1 receptor (AT1R), which is upregulated in diabetic skin and has been implicated in nociception. We investigated the effects of topical valsartan, an AT1R antagonist, on pain (nociceptive thresholds) and gene expression changes (transcriptomics) in a swine model of diabetic wounds. Eight wounds were surgically induced in diabetic, hyperglycemic Yucatan miniature swine ( n = 4). Topical AT1R antagonist was applied to wounds on one side and vehicle on the other side. Nocifensive testing was conducted at baseline and then weekly, beginning 7 days after wound induction. Mechanical and thermal stimuli were applied to the wound margins until a nocifensive reaction was elicited or a predetermined cutoff was reached. After 7 weeks of testing, tissue from the dorsal horn, dorsal root ganglion, and wounds were sequenced and analyzed with DESeq2. Unbiased pathway analyses using Metascape were conducted on differentially expressed genes. There was no significant difference in mechanical tolerance threshold between AT1R antagonist-treated and vehicle-treated wounds ( p = .106). Thermal tolerance was significantly higher in AT1R antagonist-treated wounds compared to vehicle-treated ( p = .015). Analysis of differentially expressed genes revealed enriched pathways of interest: interleukin-18 signaling in dorsal horn laminae IV-V and sensory perception of mechanical stimulus in wound tissue. In this study, wounds modeling diabetic ulcers were created in hyperglycemic swine and treated with a topical AT1R antagonist. AT1R-antagonist-treated wounds had a higher tolerance threshold than vehicle-treated wounds for thermal hyperalgesia, but not mechanical allodynia. Pathway analyses of differentially expressed genes revealed several pathways of interest for future pain research. Although further studies are needed to confirm the findings, this study can improve nursing care by providing information about a potential future treatment that may be used to decrease pain and improve HRQOL in patients with diabetic wounds.

Charged Fibrous Dressing to Promote Diabetic Chronic Wound Healing.

Diabetic chronic wounds cause a significant amount of pain to patients because of their low cure rates and high recurrence rates. Traditional approaches to treating diabetic chronic wounds often involve the delivery of drugs or cytokines that regulate the microenvironment and eliminate bacterial infection in the wound area, but they are passive in controlling cell behaviors and may lead to drug resistance. Emerging drug-free wound treatments are important for convenient, effective, and safe treatment strategies. However, the current approaches cannot fully promote tissue regeneration or prevent bacterial infections. Here, the efficacy of a negatively charged fiber dressing in promoting diabetic chronic wound healing is investigated. The negatively charged fiber dressing can generate reactive oxygen species to inhibit bacterial reproduction with the assistance of ultrasound during the inflammatory phase. Furthermore, the dressing provides an electrostatic field that regulates cellular behavior during the inflammatory and proliferative phases. In particular, the dressing can promote fibroblast migration and induce macrophage polarization and neovascularization without any additional drugs. It is demonstrated that this strategy enables the healing of diabetic chronic wounds in a mouse model, achieving effective wound closure over a 12-day treatment cycle and providing a drug-free therapeutic strategy for diabetic chronic wound care.

Injectable, antibacterial, ROS scavenging and pro-angiogenic hydrogel adhesives promote chronic wound healing in diabetes via synergistic release of NMN and Mg2+

Diabetic wound care continues a significant clinical problem due to the complex wound microenvironment characterized by excessive ROS, bacterial infection, persistent inflammation, impaired NAD+ biosynthesis, and angiopathy. Particularly, scavenging ROS, enhancing NAD+ levels and promoting angiogenesis are critical for improving diabetic wound healing. This study presents a novel in situ injectable hydrogel based on poly(glycerol sebacate)–co-poly(ethylene glycol)-g-catechol prepolymer (PEGSD) and quaternized chitosan (QCS), which is further loaded with nicotinamide mononucleotide (NMN) and Mg2+ (QP/NMN/Mg2+) and catalytically cross-linked by a mild horseradish peroxidase (HRP)/H2O2 system for type II diabetic wound healing. The hydrogel shows multifunctional properties including excellent biocompatibility, tissue adhesion, rapid hemostasis, antibacterial activity, ROS scavenging and angiogenesis promotion. The electrostatic and coordination interactions ensure the prolonged release of NMN and Mg2+. Specifically, as an NAD+ precursor, the addition of NMN further alleviates oxidative stress and rescues angiogenic capacity. Moreover, the presence of Mg2+ enhances the antibacterial activity of hydrogel against S. aureus. The results demonstrate the synergy of NMN and Mg2+ in hydrogel significantly promotes HUVEC proliferation and tube formation, fibroblast migration, and greatly accelerates diabetic wound healing, presenting a feasible strategy for chronic diabetic wound repair.

Insulin Can Delay Neutrophil Extracellular Trap Formation In Vitro-Implication for Diabetic Wound Care?

Diabetes is a worldwide evolving disease with many associated complications, one of which is delayed or impaired wound healing. Appropriate wound healing strongly relies on the inflammatory reaction directly after injury, which is often altered in diabetic wound healing. After an injury, neutrophils are the first cells to enter the wound site. They have a special defense mechanism, neutrophil extracellular traps (NETs), consisting of released DNA coated with antimicrobial proteins and histones. Despite being a powerful weapon against pathogens, NETs were shown to contribute to impaired wound healing in diabetic mice and are associated with amputations in diabetic foot ulcer patients. The anti-diabetic drugs metformin and liraglutide have already been shown to regulate NET formation. In this study, the effect of insulin was investigated. NET formation after stimulation with PMA (phorbol myristate acetate), LPS (lipopolysaccharide), or calcium ionophore (CI) in the presence/absence of insulin was analyzed. Insulin led to a robust delay of LPS- and PMA-induced NET formation but had no effect on CI-induced NET formation. Mechanistically, insulin induced reactive oxygen species, phosphorylated p38, and ERK, but reduced citrullination of histone H3. Instead, bacterial killing was induced. Insulin might therefore be a new tool for the regulation of NET formation during diabetic wound healing, either in a systemic or topical application.

A Novel Wound Therapy Modality: Autologous Wound Edge Dotted Full-Thickness Skin Grafting Improving Diabetic Foot Ulcer Healing.

To explore the therapeutic efficacy of autologous wound edge-dotted full-thickness skin grafting in improving diabetic foot ulcer healing. Sixty-three patients were divided into three groups: conventional wound therapy (CWT) (n = 23), platelet-rich plasma (PRP) (n = 20), and graft (n = 20). All participants were followed up for 12 weeks. The therapeutic efficacy of the three different wound treatment modalities was analyzed. After follow-up, 37 (58.7%) patients showed complete wound re-epithelialization, of which 10 (43.5%) occurred in the CWT group, 14 (70.0%) in the PRP group, and 13 (65.0%) in the graft group. Multivariate Cox analysis showed that the independent predictive factors for ulcer healing were different treatment modalities (graft: HR = 3.214, 95% CI=1.300-7.945, P < 0.05; platelet-rich plasma: HR = 3.075, 95% CI=1.320-7.161, P < 0.01), ABI (HR = 9.917, 95% CI=2.675-36.760, P < 0.01), and TcPO2 (HR = 1.040; 95% CI=1.005-1.076; P < 0.05). Stratified analysis showed that higher ABI in graft group or PRP group had higher wound healing rate (graft group: HR = 3.748, 95% CI=1.210-11.607, P < 0.05; PRP group: HR = 5.029, 95% CI=1.743-14.509, P < 0.05); higher TcPO2 in the graft group had higher wound healing rate (HR = 15.805, 95% CI=4.414-56.594, P < 0.01). Additionally, the wound healing time (P < 0.0167) and cumulative healing rate (P < 0.05) in both the PRP group and graft group were more advantageous. The graft group promotes wound re-epithelialization earlier and faster than in the CWT group and PRP group (P < 0.05). Meanwhile, the graft group had lower medical costs (P < 0.0167). Autologous wound edge dotted full-thickness skin grafting has a higher cost-performance ratio than traditional diabetic foot ulcer wound care and is worthy of further clinical application.

A Journey from Clinical Pharmacist to a Diabetic Foot Wound Care Pharmacist from India: An Experience from Amit Jain’s Institute of Diabetic Foot

Diabetes is a growing problem and so are its complications with diabetic foot being one of the commonest known complications. Diabetic foot is often associated with amputation that increases the morbidity and mortality. Often, multidisciplinary management consisting of prevention, education, examination, treatment etc and multidisciplinary team approach can provide favorable outcomes. One of the members among this multidisciplinary team has been a pharmacist in few of the expert diabetic foot Centre’s around the world. It is observed that, though spoken of their role in clinical practice, either such roles are limited or undervalued. Further, there are sparse publications that provides a clear-cut role, training, responsibility, and their experience in a diabetic foot team. This article provides an essential insight on the journey of one of the first diabetic foot wound care Pharmacist from India.

Pengaruh Mastery Learning terhadap Kompetensi Perawat Melakukan Pengkajian dan Perawatan Luka Ulkus Diabetikum: Tinjauan Literatur

Competence regarding the assessment and care of diabetic ulcer wounds in nurses is needed so that wound care can be carried out properly. Research on mastery learning in learning for nurses has been carried out a lot. However, there is still a lack of a literature review that looks at how effective this learning is in increasing the competence of nurses regarding the assessment and care of diabetic ulcers. The research method used is a systematic review by identifying journal articles published online consisting of English in 2018-2023. Articles were retrieved using the search engine tools Sciencedirect, Pubmed, and ProQuest. There are 4 journals based on inclusion criteria. The results of the study show that there is an influence of mastery learning in increasing the knowledge, attitudes and skills of nurses in carrying out clinical practice.

Aplikasi mHEALTH dalam Manajemen Luka Diabetik

This study aims to determine the use of mHealth in diabetic wound management. The research method uses a literature review approach through content analysis with a search method using an electronic database consisting of ProQuest, PubMed, Science Direct, Scopus, Sage, and SpringerLink with the keywords "telemedicine," "telehealth," "mobile health," "diabetic ulcer.", and "diabetic wound" published year 2018-2022. The search results obtained 612 articles, and 12 papers were reviewed after filtering. The results showed that there were four essential components in using health for diabetic wound management, namely counseling/consultation, use of wearable devices, routine foot temperature checks, and recommendations for diabetic wound care. In conclusion, mHealth positively and effectively impacts diabetic wound management.&#x0D; Keywords: Diabetic Wounds, Management, mHealth, Telehealth, Telemedicine

Polysaccharide-Based Formulations for the Treatment of Diabetic Wounds: A Review

This article highlights recent progress in the development of polysaccharide-based formulations for the treatment of diabetic wounds. Wound healing is generally slower in diabetic patients than in non-diabetic individuals, which can be complicated into cellulitis, gangrene and foot abscess. Here, the influence of diabetes on the wound healing process and the potential effects of polysaccharide-based formulations on wounds associated with diabetes mellitus are described. Polysaccharides are excellent candidates for effective skin repair due to the characteristics of biodegradability, biocompatibility, and non-toxicity. Common polysaccharides employed in the development of diabetic wound care include cellulose, hyaluronic acid, and alginate. In addition, novel polysaccharides for diabetic wound care have been extracted from natural materials used for traditional medicine, such as Ganoderma lucidum, Periplaneta americana, and psyllium seed husk. Several strategies have been adopted, including crosslinking, grafting, quaternation, nanoformulation, and polymeric composites, to improve the physicochemical and mechanical attributes of polysaccharide-based formulations. These properties are crucial to the wound healing process by facilitating wound closure via accelerated re-epithelialization and collagen synthesis, as well as maintaining an optimal moist environment while minimizing the risk of infection and scar formation. The roles of stimuli-responsive polymers, controlled-release formulations, and bioactive polysaccharides in facilitating diabetic wound healing are also discussed.

Nanofibrous insulin/vildagliptin core-shell PLGA scaffold promotes diabetic wound healing.

Introduction: Slow wound repair in diabetes is a serious adverse event that often results in loss of a limb or disability. An advanced and encouraging vehicle is wanted to enhance clinically applicable diabetic wound care. Nanofibrous insulin/vildagliptin core-shell biodegradable poly (lactic-co-glycolic acid) (PLGA) scaffolds to prolong the effective drug delivery of vildagliptin and insulin for the repair of diabetic wounds were prepared. Methods: To fabricate core-shell nanofibrous membranes, vildagliptin mixture with PLGA, and insulin solution were pumped via separate pumps into two differently sized capillary tubes that were coaxially electrospun. Results and Discussion: Nanofibrous core-shell scaffolds slowly released effective vildagliptin and insulin over 2weeks in vitro migration assay and in vivo wound-healing models. Water contact angle (68.3 ± 8.5° vs. 121.4 ± 2.0°, p = 0.006) and peaked water absorbent capacity (376% ± 9% vs. 283% ± 24%, p = 0.003) of the insulin/vildagliptin core-shell nanofibrous membranes remarkably exceeded those of a control group. The insulin/vildagliptin-loaded core-shell nanofibers improved endothelial progenitor cells migration in vitro (762 ± 77cells/mm2 vs. 424.4 ± 23cells/mm2, p < 0.001), reduced the α-smooth muscle actin content in vivo (0.72 ± 0.23 vs. 2.07 ± 0.37, p < 0.001), and increased diabetic would recovery (1.9 ± 0.3mm2 vs. 8.0 ± 1.4mm2, p = 0.002). Core-shell insulin/vildagliptin-loaded nanofibers extend the drug delivery of insulin and vildagliptin and accelerate the repair of wounds associated with diabetes.

Workshop Pencucian Luka Kaki Diabetik Menggunakan Bahan Alam bagi Perawat di Puskesmas Mapane, Kabupaten Poso, Provinsi Sulawesi Tengah

Wound care of diabetic foot ulcer by Public Health Center nurses still use povidone iodine and rivanol which are toxic to tissues. Innovations in wound care including the use of natural materials have been proven to be effective in accelerating the healing of diabetic foot ulcers. This community service activity aims to increase the knowledge and skills of Public Health Center nurses in wound care using natural materials. The implementation method, namely workshops and wound care practices using natural materials, was held for 1 day on July 11 2022 at the Mapane Health Center. The target was Public Health Center nurses, totaling 28 participant. The form of evaluation is measuring the knowledge and skills of nurses before and after the activity. The results showed that the participants knowledge increased from 60.7% to 89.3% and the average skill score increased from 9.04 to 16.14. The conclusion is that after the workshop activities there was an increase in the knowledge and skills of Public Health Center nurses for wound care using natural materials. Suggestions for Public Health Center nurses to be able to utilize natural materials in the diabetic foot wound care.

Development of novel green synthesized Zinc oxide nanoparticles with antibacterial activity and effect on diabetic wound healing process of excisional skin wounds in nursing care during sports training

The current study proposed a green, eco-friendly approach for the preparation of zinc oxide nanoparticles using leaf extract of Nigella sativa plant extract. The synthesized ZnO NPs were characterized using techniques such as FESEM, EDS, UV–Vis, FTIR and XRD. The findings obtained from DLS and FESEM revealed the formation of polydisperse ZnO NPs with an average particle size of 45 nm. Further, antidiabetic studies revealed that the treatment of diabetic mice with ZnO NPs revealed the recovery of glycogen, insulin and blood glucose levels. In addition, the present results also revealed the potential characteristics of fabricated ZnO NPs with better efficacy and low cost than the alternative treatments for diabetes. Further, this work opened the possibilities for future studies, primarily with respect to the development of new drugs for use in diabetic wound care during sports training.

New Paradigm in Diabetic Foot Ulcer Grafting Techniques Using 3D-Bioprinted Autologous Minimally Manipulated Homologous Adipose Tissue (3D-AMHAT) with Fibrin Gel Acting as a Biodegradable Scaffold

Adipose tissue is an abundant source of extracellular substances that support the tissue repair process. This pilot study was carried out to determine the efficacy of 3D-bioprinted autologous adipose tissue grafts on diabetic foot ulcers (DFUs), with fibrin gel used to stabilise the graft. This was a single-arm pilot study in a tertiary hospital that provides diabetic wound care services. A total of 10 patients with a DFU were enrolled, and the primary endpoint was complete healing within 12 weeks. The secondary endpoints were wound size reduction, time to healing, and adverse events. Seven out of ten patients showed complete healing of their DFU within 12 weeks (at 2, 4, 5, 10, and 12 weeks, respectively). The wound size reduction rate was significantly and progressively reduced over time. According to our data, autologous adipose tissue grafting using a 3D bioprinter, with the addition of fibrin gel that acts as a scaffold, promotes wound healing with high-quality skin reconstruction. Throughout this study period, no adverse events were observed.

The Influence of 6-Month Interdisciplinary Accompaniment on Family Caregivers' Knowledge and Self-Efficacy Regarding Diabetic Wound Care.

Diabetes mellitus (DM) is a global health issue. Diabetic wounds have become a severe health complication. Interdisciplinary education and the use of homecare have led to improvements in the health of patients with chronic disease. The family caregiver's knowledge and self-efficacy positively impact the DM patient's self-care in the physical and psychological dimensions. There is still a need for interdisciplinary education to enhance family caregivers' knowledge and self-efficacy regarding diabetic wound care. To determine the effect of 6 months of interdisciplinary education on family caregivers' knowledge and self-efficacy regarding diabetic wound care. A quantitative longitudinal study with a quasi-experimental, one-group, pretest-posttest design was conducted. Family caregivers received 6 months of interdisciplinary education regarding diabetic wound care. The Foot Care Confidence Scale (FCCS) was used to measure the family caregivers' knowledge and self-efficacy regarding diabetic wound care. The dependent samples t test and the Wilcoxon signed-rank test were used for statistical analysis. Sixteen caregivers of patients with diabetic ulcer wounds in the homecare unit participated in this intervention with a 6-month follow-up. Six months of interdisciplinary education significantly increased the family caregivers' knowledge (p = 0.001) and self-efficacy (p = 0.001). However, there was no significant correlation between self-efficacy and gender, age, education level, or duration of wound care (p = 0.91; 0.93; 0.38; 0.40, respectively). Long-term interdisciplinary education improved caregiver performance across genders, ages, education levels, and wound care experience durations. Long-term interdisciplinary education of family caregivers is recommended as one method to enhance the family support system with respect to diabetic ulcer care management. In addition, interprofessional collaboration could be performed to enhance the understanding of healthcare, especially diabetic ulcer care.

Knowledge, Awareness, and Practice Related to Diabetic Foot Ulcer Among Healthcare Workers and Diabetic Patients and Their Relatives in Saudi Arabia: A Cross-Sectional Study.

Background Diabetes mellitus is a chronic progressive metabolic disorder characterized by high blood sugar affecting the whole body resulting in a significant impact on the quality of life for the patients and their families. Diabetes mellitus complications lead to morbidity, disability, and mortality and represent a serious global health issue threatening the health system worldwide and resulting in a critical economic impact for all countries, especially epidemic ones. Objective The objective of this study was to assess the level of knowledge and awareness regarding diabetic foot and related behaviour among diabetic patients and their relatives, as well as healthcare workers in Saudi Arabia. Methods A cross-sectional analytic study was conducted in 2022 on healthcare workers, diabetic patients, and their relatives above the age of 18 in Saudi Arabia by using a valid, pretested structured questionnaire. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results In this study, there was no correlation between the healthcare workers' attitude and knowledge. A total of 131 healthcare workers were involved, and a majority of them had good knowledge regarding the predisposing factors of diabetic foot ulcers, and 63 (48.1%) had good knowledge regarding diabetes foot care. On the other hand, there was poor knowledge regarding the characteristics and complications of diabetes ulcers. This study showed various attitudes among healthcare workers regarding diabetic ulcer care. For example, they prioritized the prevention of ulcers over treatment (N=67, 51.1%), the majority of healthcare workers were very keen to wound care (N=77, 58.8%), and they believed that it was their responsibility to educate their patients about reducing re-ulceration (N=86; 65.7%). However, 52 participants (39.7%) considered management of diabetic foot ulcer time-consuming, 54 (41.2%) mentioned that if they had the opportunity, they would like to avoid taking care of the diabetic wound, and 51 (38.9%) reported non-satisfaction with diabetic wound care. One hundred diabetic patients and 117 relatives also were involved, and only 41.3% of participants (patients and relatives) had good knowledge regarding diabetes mellitus. However, our findings also revealed that 91.65% of the participants had good knowledge and a favourable attitude towards diabetes mellitus and diabetic foot care. Nevertheless, even though the participants had good knowledge regarding foot care, they had poor practice, with 56.55% scoring poor on the assessment questionnaire. Conclusion Our study shows that most of the participants had good knowledge and attitudes but poor practices. This highlights the need for more efforts to educate the Saudi population about diabetes and its complications.

Adipose-Derived Stem Cell Extracellular Vesicles Improve Wound Closure and Angiogenesis in Diabetic Mice.

Currently, there is a lack in therapy that promotes the reepithelialization of diabetic wounds as an alternative to skin grafting. Here, the authors hypothesized that extracellular vesicles from adipose-derived stem cells (ADSC-EVs) could accelerate wound closure through rescuing the function of keratinocytes in diabetic mice. The effect of ADSC-EVs on the biological function of human keratinocyte cells was assayed in vitro. In vivo, 81 male severe combined immune deficiency mice aged 8 weeks were divided randomly into the extracellular vesicle-treated diabetes group (n = 27), the phosphate-buffered saline-treated diabetes group (n = 27), and the phosphate-buffered saline-treated normal group (n = 27). A round, 8-mm-diameter, full-skin defect was performed on the back skin of each mouse. The wound closure kinetics, average healing time, reepithelialization rate, and neovascularization were evaluated by histological staining. In vitro, ADSC-EVs improved proliferation, migration, and proangiogenic potential, and inhibited the apoptosis of human keratinocyte cells by suppressing Fasl expression with the optimal dose of 40 μg/mL. In vivo, postoperative dripping of ADSC-EVs at the dose of 40 μg/mL accelerated diabetic wound healing, with a 15.8% increase in closure rate and a 3.3-day decrease in average healing time. ADSC-EVs improved reepithelialization (18.2%) with enhanced epithelial proliferation and filaggrin expression, and suppressed epithelial apoptosis and Fasl expression. A 2.7-fold increase in the number of CD31-positive cells was also observed. ADSC-EVs improve diabetic wound closure and angiogenesis by enhancing keratinocyte-mediated reepithelialization and vascularization. ADSC-EVs could be developed as a regenerative medicine for diabetic wound care.

Heliconia rostrata Extract Mediated Synthesis of GNPs and Their Anti-Diabetic and Wound Healing Properties for Applications in Diabetic Wound Care

Herein, we reported a novel application of the aqueous extract of Heliconia rostrata leaves to fabricate gold nanoparticles (GNPs) by the deoxygenation of Tetrachloroaurate (AuCl−4) ions. The phyto-chemicals existing in the leaf extract acted as a potential capping and reducing agents. The obtained GNPs were studied with the help of various characterization techniques like X-RD, TEM and UV-Vis spectroscopy. TEM analysis displayed that the fabricated GNPs were of different sizes and shapes ranges existed from 8–15 nm. High-resolution TEM and SAED images indicated high crystallinity and FCC phase of the NPs. The XRD analysis pattern displayed a (1 1 1) preferred orientation of GNPs. FTIR spectroscopy measurements displayed GNPs with a layer of phenolic compounds, suggesting a probable role of biomolecules accountable for capping and effective stabilization of GNPs. α-amylase and α-glucosidase inhibitory assays were used to evaluate antidiabetic efficacy. The IC50 values for the α-amylase and α-glucosidase activities of Au NPs were 221 and 290 μg/ml, correspondingly. The IC50 value for the enzymatic assay validated the impact dose-dependently. Wound healing studies revealed that GNPs demonstrated a 99% wound closure after 5 days. As per PCR findings, the expression of CD-4 and NANOG was much higher in NPs treated wound tissues than in untreated ones. All these results revealed that prepared NPs exhibited good anti diabetic and wound healing activity in wound care.

Nursing students’ knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia

ObjectiveThe prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students’ knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them. MethodsA cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis. ResultsThe results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96–20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19–0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40–5.41, P = 0.003). ConclusionFindings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students’ knowledge and attitudes based on the factors discovered in this study.