Ulcer Complications Research Articles

Predictive value of neutrophil-lymphocyte ratio in assessing the outcomes of diabetic foot ulcer

Objective: To assess the correlation of neutrophil-lymphocyte ratio with clinical outcomes in diabetic foot ulcer cases. Method: The retrospective, cross-sectional, single-centre study was conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan), and comprised data from January 2019 to January 2022 of diabetic foot inpatients of either gender aged at least 18 years. Un-hospital complications and outcomes were noted along with other data on a self-designed proforma. Diagnostic performance of neutrophil-lymphocyte ratio and its correlation with qualitative variables were assessed. Data was analysed using SPSS 26. Results: Of the 130 patients with mean age 60.13+/-11.75 years, 98(75.4%) were males. Surgical intervention was needed in 118(90.8%) cases, with below-knee amputation being the most frequent procedure 38(32.3%). Neutrophil-lymphocyte ratio >4 was significantly associated with a higher grade of diabetic foot ulcer, major amputation, and postoperative complications (p<0.0001) as well as with in-hospital (p=0.008) and 1-year mortality (p=0.01). Conclusion: Neutrophil-lymphocyte ratio could be potentially used as a sensitive and economically feasible biomarker for evaluating the prognosis of patients presenting with diabetic foot ulcers. Key Words: Diabetic foot, Outcomes, Complications, Surgery.

Emerging technologies for the management of diabetic foot ulceration: a review.

Diabetic foot ulcers (DFUs) and infections are common complications that frequently result in reduced quality of life and even morbidity for patients with diabetes. This paper highlights significant findings in DFU treatments and emerging advanced technologies for monitoring ulceration in patients with diabetes. The management of DFUs requires a multidisciplinary approach that involves patient education. It is well-established that poor glycemic control significantly contributes to diabetic foot ulcer complications, presenting global challenges in quality of life, economics, and resource allocation, affecting approximately half a billion people and potentially leading to lower limb amputation or mortality. Therefore, effective DFU management necessitates a multidisciplinary approach that includes patient education. However, current clinical guidelines for DFU treatment are not performing effectively, resulting in unnecessary increases in financial and emotional burden on patients. Researchers have experimented with advanced technologies and methods, including traditional approaches, to address complications related to DFU healing. This paper also presents the evolution of patents in the field of DFU medication and advanced diagnostic methods, showcasing relevant innovations that may benefit a wide range of researchers.

The effect of the type of constitution on the course of gastric ulcer in children

The purpose of the study. The study of the constitutional features of the course of gastric ulcer in children. Materials and methods. 102 children aged 12-17 years with a diagnosis of “gastric ulcer” were examined. A clinical and instrumental verification of the diagnosis, its complications, and an assessment of the type of constitution using the Pinier index was carried out using endoscopic examination. Results and conclusion. The dominance of children with gastric ulcer, having an asthenic type of constitution in comparison with normal and hypersthenics, has been established. Complications of gastric ulcer in the form of perforation of the stomach wall with the development of peritonitis, gastric bleeding were significantly more common in normosthenic patients, one and a half to two times less common in asthenics, never noted in hypersthenics, in whom concomitant reflux esophagitis was often detected.

S2075 Assessing PPI Administration Strategies to Minimize Marginal Ulceration Complications Following Roux-en-Y Gastric Bypass

S2075 Assessing PPI Administration Strategies to Minimize Marginal Ulceration Complications Following Roux-en-Y Gastric Bypass

Penerapan Pencucian Luka Menggunakan Air Rebusan Daun Jambu Biji pada Malodor Luka Diabetes Mellitus di Wilayah Sragen

Data from the Word Health Organization (WHO) shows that the incidence of diabetes mellitus in adults in 2021 is 9.1% in the world. Cases of diabetes mellitus in Indonesia reached a total of 19.47 million with sufferers in Central Java 7.3%. The prevalence of DM in 25 health centers in Sragen Regency was 21,461 people in 2019 and has the potential to experience complications of diabetic ulcers which if left untreated will cause wound tissue regeneration to be disrupted resulting in bacterial infection and an impact on the appearance of odor in the wound. For this reason, it is necessary to make efforts to wash the wound so that the wound remains clean and odorless. One of them is by washing the wound using guava leaf decoction water. To determine the effectiveness of guava leaf decoction to reduce malador in diabetic ulcers. This type of research uses descriptive research methods and by observing 2 respondents with a history of diabetes mellitus and given the implementation of wound washing using guava leaf decoction. Malador and pain scale after the intervention experienced an improved status. There is an effect on wound washing using guava leaf decoction on wounds.

Perforated Peptic Ulcer in Lagos. Risk Factors and Management Outcome

Abstract Background: Complications of peptic ulcers, such as bleeding, gastric outlet obstruction, and perforation, can be life-threatening and may require surgical intervention. Perforated peptic ulcer (PPU) presents mostly as a surgical emergency and is one of the leading causes of secondary peritonitis with significant morbidity and mortality. The clinical outcome of surgical treatment of peptic ulcers varies due to the varying patterns of presentations and interventions between countries. There are few documented series on PPU in Nigeria. This paper reviews the management outcome of PPU in our institution. Materials and Methods: A retrospective review of the available medical records of patients managed for PPU between February 2008 and February 2023 was conducted. All patients had a single anterior peptic ulcer perforation managed by a modified Graham’s patch. Data analysis was performed using IBM SPSS for Windows, Version 23 (IBM Corp., Armonk, NY, USA). Results: There were 107 PPU patients comprising 93 males and 14 females. The mean age of all patients was 41 years. The peak prevalence of PPU was found among patients aged 30–39 years. Delayed presentation was recorded in about half of the patients. Ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) was the most common risk factor for PPU. Among the 93 documented cases, perforated gastric ulcers (71 cases) were found in a much higher proportion than duodenal ulcers (22 cases). Large ulcer (10–30 mm) was the main perforation size category found in 47 out of 83 recorded PPU cases. PPU size was not associated with the incidence of complications or mortality. The median duration of hospital stays was 13 (1–19) days. Surgical site infection was the most common complication after surgery. Conclusion: PPU is present in our predominantly male patients in their fourth decade of life. Ingestion of NSAIDs is a major risk factor. Duodenal ulcers were the predominant type seen in our patients. Documented perforated ulcer sizes in our patients are predominantly in the large category. Surgical site infection, systemic sepsis, and superficial wound infection were major complications in our patients.

General practice variation in peptic ulcer prophylaxis: a nationwide register-based study

Background Incidence of peptic ulcer bleeding can be substantially reduced by prophylactic use of proton pump inhibitors (PPIs) in patients at risk, but use of PPI varies among risk patients, and substantial under-prescribing may exist. The variation in prophylactic prescribing among general practices remains unknown. Methods A nationwide register-based cross-sectional study analyzing the proportion of patients at risk of ulcer bleeding receiving PPI treatment within Danish general practices. Using logistic regression, we analyze associations between general practice characteristics and prophylactic treatment among patients at risk of ulcer bleeding listed with the general practice. Results In most general practices, less than 40% of the patients at increased risk of ulcer bleeding were covered by PPI. Geographical variation was present, where practice location outside the capital area was associated with higher odds of PPI coverage among their risk patients. Partnership practices with GPs with a mean age ≥65 years or with only female GPs were associated with higher odds of providing prophylaxis among their risk patients compared to practices with a mean GP age <45 years or with only male GPs. Similar associations were not found for single-handed practices. Conclusions A significant under-prescribing of ulcer prophylaxis is common across all general practice characteristics, and only few associations with practice characteristics were present. Most efforts to rationalize PPI prescribing have aimed at reducing overprescribing but the findings point to under-prescribing as a problem as well. Development of new methods to assist GPs in identifying individuals at risk of ulcer complications is needed.

Novel Nano Drug-Loaded Hydrogel Coatings for the Prevention and Treatment of CAUTI.

Catheter-associated urinary tract infection (CAUTI) is a prevalent type of hospital-acquired infection, affecting approximately 15% to 25% of patients with urinary catheters. Long-term use of the catheter can lead to colonization of microorganisms and biofilm formation, and may develop into bacterial CAUTI. However, the frequent replacement of catheters in clinical settings can result in tissue damage, inflammation, ulceration, and additional complications, causing discomfort and pain for patients. In light of these challenges, a novel nanodrug-supported hydrogel coating called NP-AM/FK@OMV-P/H has been developed in this study. Through in vitro experiments, it is confirmed that OMV nano-loaded liquid gel coating has an effective reaction against E.coli HAase and releases antibacterial drugs. This coating has also demonstrated strong inhibition of E.coli and has shown the ability to inhibit the formation of bacterial biofilm. These findings highlight the potential of the OMV nanoparticle gel coating in preventing and treating bacterial infections. Notably, NP-AM/FK@OMV-P/H has exhibited greater efficacy against multidrug-resistant E.coli associated with UTIs compared to coatings containing single antimicrobial peptides or antibiotics. Additionally, it has demonstrated good biosecurity. In conclusion, the NP-AM/FK@OMV-P/H coating holds great potential in providing benefits to patients with CAUTI.

Liraglutide Promotes Diabetic Wound Healing via Myo1c/Dock5.

Non-healing diabetic wounds and ulcer complications, with persistent cell dysfunction and obstructed cellular processes, are leading causes of disability and death in patients with diabetes. Currently, there is a lack of guideline-recommended hypoglycemic drugs in clinical practice, likely due to limited research and unclear mechanisms. In this study, it is demonstrated that liraglutide significantly accelerates wound closure in diabetic mouse models (db/db mice and streptozotocin-induced mice) by improving re-epithelialization, collagen deposition, and extracellular matrix remodeling, and enhancing the proliferation, migration, and adhesion functions of keratinocytes. However, these effects of improved healing by liraglutide are abrogated in dedicator of cytokinesis 5 (Dock5) keratinocyte-specific knockout mice. Mechanistically, liraglutide induces cellular function through stabilization of unconventional myosin 1c (Myo1c). Liraglutide directly binds to Myo1c at arginine 93, enhancing the Myo1c/Dock5 interaction by targeting Dock5 promoter and thus promoting the proliferation, migration, and adhesion of keratinocytes. Therefore, this study provides insights into liraglutide biology and suggests it may be an effective treatment for diabetic patients with wound-healing pathologies.

Evaluating the Safety of the Intragastric Balloon: Spanish Multicenter Experience in 20,680 Cases and with 12 Different Balloon Models.

Intragastric balloon (IGB) is a minimally invasive and reversible option for obesity treatment. There is a worldwide growing number of different IGB models. The efficacy and safety profile for each model must be demonstrated. We aim to evaluate IGB safety profile according to the experience of the Spanish Bariatric Endoscopy Group (GETTEMO). A survey of 37 IGBs safety-related questions was sent to all GETTEMO members, to retrospectively collect a multicenter Spanish registry. Incidence, causes, and resolution of both major and minor complications and adverse events (AEs), including legal consequences, differentiated for each balloon model were evaluated. Secondary outcome was weight loss data to confirm efficacy. Twenty-one Spanish hospitals experienced in IGBs responded. The overall data encompassed 20,680 IGBs, including 12 different models. Mean %TBWL of 17.66 ± 2.5% was observed. Early removal rate due to intolerance was 3.62%. Mean major complications rate was 0.70% (> 1% in Spatz2, HB, and Spatz3 models), mainly complicated gastric ulcer. Minor AEs rate was 6.37%, mainly esophagitis. Nine cases (0.04%) required surgery. A single case of mortality (0.0048%) occurred. Seven lawsuits (0.0034%) were received, all with favorable resolution. In the Spanish experience accumulating 20,680 IGBs and including 12 different balloon models, a low incidence rate of major complications and minor AEs are observed (0.70% and 6.37%, respectively), mostly resolved with medical/endoscopic management. IGB shows good tolerance and efficacy profile. These safety data are within the accepted quality standards.

Analysis of the Profile of Primary Diagnosis Codes for Diabetes Mellitus Inpatients at Dr. Soekardjo Regional General Hospital Tasikmalaya Based on ICD-10, ICD-11, and SNOMED CT

Background: the accuracy of a diagnosis code is essential in financing health services and diseases and procedure indexing and hospital management information. Based on the results of the preliminary study, diabetes mellitus is among the top 10 diseases. While coding 10 medical record documents, three consisted of 30% which were accurate, and the seven recorded 70% were found to be accurate. The four-character of the code was predominantly the character with many inaccuracies. Therefore, the researchers conducted a study on the accuracy of a diagnosis code at Dr. Soekardjo Regional General Hospital specifically on inpatient cases of diabetes mellitus in 2022. Methods: A quantitative type of study with a descriptive research design was implied in the study. The study object is data coding of diabetes mellitus cases. Data are collected by observation and interviews Results: According to the research results, diabetes mellitus is one of the top 10 diseases, while 40 medical record documents were coded, 20 (50%) were inaccurate and 20 (50%) were accurate, while the highest percentage of unaccuracy occurs in the fourth character of the code. The alignment of codes based on ICD-11 revealed that 10 documents (25%) were not aligned due to lack of specificity regarding ulcer complications and gastropathy.The alignment of codes based on SNOMED CT showed that 40 documents were aligned with the SNOMED CT clinical phrase standards. Conclusion: The inaccuracies in diabetes mellitus diagnosis coding at Dr. Soekardjo Regional General Hospital are attributed to less specific diagnoses, unclear handwriting by doctors in patient medical records, and coding personnel still facing difficulties in determining complication coding. The researchers suggest solutions such as involving coders and medical personnel in training and socialization activities related to diagnosis codes, particularly for Diabetes Mellitus.

Evaluation of Immunological Levels of IL-37, IL-38, and IL-17A in Iraqi Patients with Diabetic Foot Ulcers

t Diabetes mellitus, a significant cause of mortality around the globe, can result in several secondary complications, including diabetic foot syndrome, which is brought on by diabetic neuropathy and ischemia. Approximately 15% of diabetic patients suffer from diabetic foot complications, which results in high rates of morbidity and mortality of people with Diabetes mellitus. The study's objective is to measure serum levels of IL-37, IL-38 &amp; IL-17A in diabetic mellitus (type 1 &amp; 2) patients with and without diabetic foot ulcer complications and in the control group as well as the possibility of using them as early biomarkers for diagnosis of diabetic mellitus complications &amp; future prevention. Overall, of 193 participants included in this case-control study, they were divided into three groups: the first one contains patients with type 1 diabetes mellitus (29 with diabetic foot ulcer DFU+ 35 non-diabetic foot), the second group includes type 2 diabetes mellitus patients (41 with DFU + 38 Non). The third group includes (50) as apparently healthy controls. Serological techniques of sandwich ELISA did laboratory tests for specific serum human IL-37, IL-38, and IL- 17A. The study revealed that IL-37 and IL-17A levels were significantly high (P&lt;0.01) in all diabetic groups compared to the control healthy group. The results of IL-38 show substantially higher levels of T1DM and T2DM (P&lt;0.05) compared to the control group. In addition, the DFU group of T2DM illustrated higher levels of IL-37, IL-38, and IL-17A compared with other diabetic groups. In conclusion, Iraqi DM subjects with and without complications had higher values of interleukins, IL-37, IL-38, and IL-17A, than healthy controls, which suggests an inflammatory state in these patients. In addition, the DFU of T2DM patients expressed higher levels of interleukins than other diabetic groups. This can be focused on using them as novel therapeutic targets for preventing and treating DM complications. As well as the possibility of using them as markers of inflammation and progression for complications in DM patients.

Changes in daily nursing needs and self-care capability of people with diabetes after in-hospital treatment for foot complications: A descriptive study.

A limited number of studies discuss the changes in patients' self-care skills and needs for assisted self-care after discharge from in-patient treatment due to diabetes foot ulcer-related complications. The aim of this study was to examine the ability to perform self-care and needs for assisted nursing interventions at hospital discharge, compared to pre-admission, for people with diabetes admitted and treated for foot ulcer-related complications. Retrospective patient record study. A retrospective assessment was done on the medical records of a total of 134 patients with diabetes consecutively admitted to a specialist in-patient unit due to foot ulcer complications, between 1 November 2017 and 30 August 2018. Data on daily self-care needs and home situations at admission and discharge were recorded. The median age was 72 years (38-94), 103 (76.9%) were men and 101 (73.7%) had diabetes type 2. The median length of admission was 10 days (2-39). Infection was the most common cause of admission (51%), with severe ischaemia in 6%, and a combination of both in 20% of patients. Surgical treatment was performed in 22% and vascular intervention in 19% of patients. The percentage of patients discharged to their home without assistance was 48.1% compared to 57.5% before admission, discharge to home with assistance was 27.4% versus 22.4% before admission and 9.2% were discharged to short-term nursing accommodation versus 6% before admission. Three patients died during their stay in hospital. The need for help with medications increased from 14.9% of patients at admission to 26.7% at discharge and for mobility assistance from 23.1% to 35.9%. Social services at home were increased in 21.4% of patients at discharge.

Vertical contour calcanectomy: A case series in rural Northeastern Pennsylvania

Diabetes is an epidemic in the United States contributing to poor outcomes related to ulceration and lower leg amputations. Physicians from a number of specialties are continuing to seek opportunities to improve patient outcomes and maintain independence. Podiatric surgeons have an affinity for limb salvage in the face of acute or chronic ulcer complications of the lower extremity. In particular, heel ulcerations increase the risk of proximal amputation due to locality and the propensity for heel osteomyelitis. Partial calcanectomy (PC) had been a viable option prior to below knee amputation, but recent literature by Elmarsafi et al. shows an increasing number of positive outcomes with a new procedure called the vertical contour calcanectomy (VCC). This has prompted researchers from Georgetown University to develop and publish this technique since 2019. The purpose of this article was to validate the versality and reproducibility of limb salvage with use of the VCC in the rural region of Northeast Pennsylvania in the management of complicated infections of the heel.

Prevalence and factors associated with inappropriate continuation of stress ulcer prophylaxis at discharge

Stress ulcer prophylaxis is started in the critical care unit to decrease the risk of upper gastrointestinal ulcers in critically ill persons and to decrease mortality caused by stress ulcer...

Association between onychomycosis and ulcerative complications in patients with diabetes: a longitudinal cohort study in Dutch general practice

IntroductionDiabetic foot ulcers are feared complications of diabetes mellitus (DM), requiring extensive treatment and hospital admissions, ultimately leading to amputation and increased mortality. Different factors contribute to the development of...

Identification of vanA gene on Vancomycin-Resistant Staphylococcus aureus from Diabetic Ulcer Isolate at Lampung Province

Staphylococcus aureus is a type of bacteria that causes an increasing number of infections in hospitals, particularly in diabetic ulcers. Over the last few decades, there has been an alarming increase in the prevalence of pathogen strains of Staphylococcus aureus resistant to antibiotics such as Vancomycin. This study aimed to identify the presence of the vanA gene, which is responsible for the mode of Vancomycin resistance in Staphylococcus aureus Lampung isolate. Ulcer swab was collected from 32 patients with ulcer complications from surgical Installation, Internal Medicine, Home Diabetes Wound Clinic and Diabetes Wound Center in Bandar Lampung. Among the total ulcer swab, 12 samples of S. aureus were identified and subjected to the Minimum Inhibitory Concentration test to identify Vancomycin Resistant Staphylococcus aureus and evaluated the vanA gene by Polymerase Chain Reaction. To detect the presence of the vanA gene, a Polymerase Chain Reaction was performed on Staphylococcus aureus, Vancomycin-Resistant Staphylococcus aureus, and Vancomycin-intermediate Staphylococcus aureus using a specific primer arrangement. There were two samples of Vancomycin- Resistant Staphylococcus aureus and one sample of Vancomycin-intermediate Staphylococcus aureus from the Minimum Inhibitory Concentration test but only one sample tested positive for the vanA gene on Polymerase Chain Reaction. There is Staphylococcus aureus resistance to Vancomycin in Lampung isolate and the vanA gene was detected in some resistant isolates. The arrangement of the vanA gene in the Lampung isolate is different from that of the vanA gene in other places isolates.

P238: The use of artificial intelligence in 3D imaging modalities and diabetic foot disease – a systematic review

Abstract Introduction Diabetic foot disease (DFD) is serious complication of diabetes with a multifactorial aetiology and carries a significant risk. The prevalence of DFD continues to grow globally. Artificial intelligence has been proposed in aiding early detection and risk stratification for ulceration and other major complications including sepsis, minor or major lower limb amputation and death. Aims To systematically review the literature available on the use of artificial intelligence in three-dimensional imaging modalities in diabetic foot disease. Method A literature review was conducted in accordance with PRISMA guidelines. Embase and Medline (via the Ovid interface), CINAHL (via Ebsco Host), Web of Science and Scopus databases were searched. The grey literature was also reviewed on ClinicalTrials.gov and the NIHR journals library. The medical subject headings terms “Diabetes” AND “Diabetic foot disease” AND “Artificial intelligence” and various permutations of three-dimensional imaging modalities including “Computed Tomography”, “Magnetic Resonance Imaging” and “Positron Emission Tomography” were employed in the primary search string. Articles were independently screened by two reviewers. Results 4,865 studies were identified. 102 duplicates were removed. 4,721 were excluded in the abstract screening. 42 articles underwent full text review. Existing use centers around binary use of CT based imaging in predicting risk. Conclusion The use of deep learning models is still being explored and evaluated. Current methodologies focus on wound imaging classification, plantar thermography and plantar pressures. Specialised models which evaluate 3D imaging have potential for generation of supra-human insights into extraction of novel metadata features and prediction utilising integration of multidimensional patient characteristics.

Hubungan Perilaku Perawatan Kaki Dengan Terjadinya Komplikasi Diabetic Foot Ulcer Pada Pasien DM Tipe 2 Di RSUD Pagelaran Cianjur Tahun 2023

Diabetes Mellitus is a chronic disease characterized by an increase in blood sugar levels, the cause of which is unhealthy lifestyle behavior, lack of physical activity and stress, which can cause various chronic complications. A complication that is often found in sufferes with type 2 diabetes melilitus is diabetic foot ulcers which are open wounds on the surface of the skin of the feet. A further impact of diabetic foot ulcers is amputation. Prevention that can be done for these complications is to have good foot care behavior. Objective: Tis study was to determine the relationship between foot care behavior and the event of complications of diabetic foot ulcers in RSUD Pagelaran Cianjur. Methods: This study used analytic descriptive quantitative method with Cross-sectional technique with 30 respondents. Results: Based on the results of the analysis using the Chi-square statistical test obtained p = 0,000 &lt; α = 0,05 then Ha is accepted, which means there is a relationship between foot care behavior and the event of complications of diabetic foot ulcers in patients whit type 2 diabetes mellitus in RSUD Pagelaran Cianjur . Conclusion: That there are is a significant relationship between foot care behavior and the event of complications of diabetic foot ulcers in patients whit type 2 diabetes mellitus in RSUD Pagelaran Cianjur. Suggestion: It is hoped that good foot care behavioe will be maintained by patients with type 2 diabetes mellitus so that complications of diabetic foot ulcesr can be prevented

Limb Amputations in a Tertiary Care Hospital, North India: A Cross-sectional Epidemiological Study – Can We Prevent This?

Abstract Background: Disability due to limb amputations is a major but preventable public health problem that is associated with profound economic, social, and psychological effects on the patients and their families, especially in developing countries where the supportive (prosthetic) services are meager or almost absent. The purpose of this study was to outline the patterns and indications for limb amputations in a tertiary care center of northern India and to compare our experience with that of other published data. Materials and Methods: This was an observational study conducted at a tertiary care hospital in northern India. All the patients who underwent limb amputations at this hospital between January 2018 and April 2020 were included in the study. Results: A total of 37 patients underwent various amputations during the study period. The age group ranged between 12 and 80 years (mean of 54.9 years) and the most effected age group was between 50 and 60 years (45%). Males outnumbered females with a ratio of 4:1. When the pattern of amputations was studied, 34 were lower limb amputations and 3 were upper limb amputations. On subcategorization, 45% underwent below-knee amputations followed by above-knee amputations (29%). Diabetes mellitus was the most common cause, followed by trauma and peripheral arterial disease. Conclusion: Complications of diabetic foot ulcers and trauma resulting from road traffic accidents were the most common indications for major limb amputation in our study. Implementation of comprehensive care for diabetes by multidisciplinary approach via diabetic clinics at all the hospitals can help in reducing the complications of diabetes thus reducing the disability due to amputations. Road traffic accidents can also be reduced or prevented by implementing stricter laws and increasing the social awareness.