Decrease In Ulcer Size Research Articles

Short-term effect of dressing with Dermaheal ointment in the treatment of diabetic foot ulcer: A double-blinded randomized controlled clinical trial.

Diabetic foot ulcers, a major cause of amputations in diabetics, could benefit from natural products as adjuncts to standard care, given the costs and adverse effects of typical therapies. This study aims to evaluate the short-term effects of dressing with Dermaheal ointment in the treatment of DFUs through a double-blinded randomized controlled clinical trial. This double-blinded, placebo-controlled trial included 50 patients with Wagner's ulcer grade I or II, randomly assigned to Dermaheal and placebo groups (received standard treatment and placebo ointment). The ulcer site was dressed daily for four consecutive weeks with either Dermaheal or placebo ointment. Ulcer healing score (using DFU healing checklist), ulcer size with transparent ruler and largest dimension of ulcer, and pain severity using numerical pain rating score (were recorded at five-time points, including baseline, and on weeks 1, 2, 3, and 4). Also, ulcer healing status was investigated at the trial ended in November 2021. Both groups showed significant improvement in ulcer healing over 4 weeks (p time < 0.001), with more remarkable progress in the Dermaheal group (p group = 0.03). At the trial end, complete ulcer healing was also significantly higher in the Dermaheal group compared to the placebo group (56% vs. 12%, p = 0.002). Both groups exhibited a decrease in ulcer size (p time < 0.001). Considering the baseline ulcer size as a covariate, substantial changes in mean ulcer size were noted in the initial (p = 0.01), second (p = 0.001), third (p = 0.002), and fourth (p = 0.002) weeks of the intervention, showing a preference for the Dermaheal group. However, no significant between-group difference was observed in pain severity levels. Dressing with Dermaheal as a topical treatment shows promise in improving healing and reducing the size of diabetic foot ulcers. Further research is needed to confirm these findings' long-term efficacy.

Lycium barbarum polysaccharide-glycoprotein ameliorates ionizing radiation-induced epithelial injury by regulating oxidative stress and ferroptosis via the Nrf2 pathway.

Radiation-induced oral mucositis (RIOM) is considered to be the most common acute side effect of radiation therapy and occurs during intentional or accidental radiation exposure. Antioxidant synthesis agents have been reported to protect against or alleviate the development of mucositis, but the resulting side effects of chemical synthesis agents limit their use in clinical practice. Lycium barbarum polysaccharide-glycoprotein (LBP), a polysaccharide extract of the Lycium barbarum fruit, has superior antioxidant capacity and biosafety and is a potential option for radiation prevention and treatment. Here, we aimed to investigate whether LBP conferred radioprotection against ionizing radiation-induced oral mucosal damage. We found that LBP exerted radioprotective effects in irradiated HaCaT cells, improving cell viability, stabilizing mitochondrial membrane potential, and decreasing cell death. LBP pretreatment reduced oxidative stress and ferroptosis in radioactivity-damaged cells by activating the transcription factor Nrf2 and promoting its downstream targets, such as HO-1, NQO1, SLC7A11, and FTH1. Knockdown of Nrf2 eliminated the protective effects of LBP, implying the essential role of Nrf2 in LBP activity. Additionally, the topical application of LBP thermosensitive hydrogel on rat mucosa resulted in a significant decrease in ulcer size in the irradiated group, suggesting that LBP oral mucoadhesive gel may be a potential tool for the treatment of irradiation. In conclusion, we demonstrated that LBP attenuates ionizing radiation-induced oral mucosa injury by reducing oxidative stress and inhibiting ferroptosis via the Nrf2 signaling pathway. LBP may be a promising medical countermeasure against RIOM.

Effect of Negative Pressure Wound Therapy on Diabetic Foot Ulcers

BACKGROUND&#x0D; In this study, we wanted to evaluate the effect of negative pressure wound therapy on diabetic foot ulcers.&#x0D; METHODS&#x0D; This was a hospital based prospective comparative study, conducted among 40 patients who came for treatment of diabetic foot ulcers to the Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, over a period of 2 years from September 2019 to September 2021, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.&#x0D; RESULTS&#x0D; The increase in amount of granulation tissue negative pressure wound therapy (NPWT) and saline-soaked gauzed dressing (SSGD groups were found to be statistically significant. Mean change (increase in granulation tissue in NPWT &amp; SSGD groups) from day 0 to day 42 were 78.083 % and 66.103 % respectively. Whereas in NPWT and SSGD groups, the size of ulcer was decreased which was statistically significant. Mean decrease in ulcer size in NPWT &amp; SSGD groups from day 0 to day 42 were 52 cm sq and 29.15 cm sq respectively. The mean duration of stay in hospital in NPWT &amp; SSGD groups were 29.35 + 4.51 days and 32.75 + 4.75 days with p value of 0.02, which is statistically significant. Among patients with NPWT, response was present in 95 % (19) patients and among patients with SSGD, response was present in 85 % (17) patients. The association between the groups was found to be statistically not significant.&#x0D; CONCLUSIONS&#x0D; Length of stay was shorter in the NPWT group when compared with that of SSGD group. Rate of granulation tissue formation was faster in NPWT group when compared to SSGD group. Reduction in ulcer size was significantly better in the NPWT group. Patient compliance and satisfaction was better in NPWT group. Lesser number of changes of dressings were needed in the NPWT group. It could be concluded that negative pressure wound therapy helps in faster healing, better, safe, and convenient as compared to saline soaked gauzed dressing in the treatment of diabetic foot ulcers.

EFFICACY OF 1% TOPICAL VORICONAZOLE IN THE TREATMENT OF MYCOTIC CORNEAL ULCER : A CLINICAL STUDY

Aim:To evaluate the efcacy of topical Voriconazole in the treatment of fungal corneal ulcer. Materials and methods: It was a single centre prospective tertiary care hospital based study conducted in the Upgraded Department of Ophthalmology at DARBHANGA MEDICAL COLLEGE AND HOSPITAL, Laheriasarai. It included 25 corneal ulcer patients of all demographic and socioeconomic status attending outdoor and/or indoor of Department of Ophthalmology, from April 2019 to April 2020, for a period of one year. Result: Majority of the patients were females.The decrease in ulcer size and improvement in visual acuity post treatment with topical Voriconazole was found to be statistically signicant. Conclusion: Topical therapy with 1% Voriconazole (w/v) served to be an economical mode of treating fungal corneal ulcer. It helped in the early and complete resolution of the ulcer with no adverse effects.

Dressings and topical agents for arterial leg ulcers.

It is estimated that up to 1% of people in high-income countries suffer from a leg ulcer at some time in their life. The majority of leg ulcers are associated with circulation problems; poor blood return in the veins causes venous ulcers (around 70% of ulcers) and poor blood supply to the legs causes arterial ulcers (around 22% of ulcers). Treatment of arterial leg ulcers is directed towards correcting poor arterial blood supply, for example by correcting arterial blockages (either surgically or pharmaceutically). If the blood supply has been restored, these arterial ulcers can heal following principles of good wound-care. Dressings and topical agents make up a part of good wound-care for arterial ulcers, but there are many products available, and it is unclear what impact these have on ulcer healing. This is the third update of a review first published in 2003. To determine whether topical agents and wound dressings affect healing in arterial ulcers. To compare healing rates and patient-centred outcomes between wound dressings and topical agents. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 28 January 2019. Randomised controlled trials (RCTs), or controlled clinical trials (CCTs) evaluating dressings and topical agents in the treatment of arterial leg ulcers were eligible for inclusion. We included participants with arterial leg ulcers irrespective of method of diagnosis. Trials that included participants with mixed arterio-venous disease and diabetes were eligible for inclusion if they presented results separately for the different groups. All wound dressings and topical agents were eligible for inclusion in this review. We excluded trials which did not report on at least one of the primary outcomes (time to healing, proportion completely healed, or change in ulcer area). Two review authors independently extracted information on the participants' characteristics, the interventions, and outcomes using a standardised data extraction form. Review authors resolved any disagreements through discussion. We presented the data narratively due to differences in the included trials. We used GRADE to assess the certainty of the evidence. Two trials met the inclusion criteria. One compared 2% ketanserin ointment in polyethylene glycol (PEG) with PEG alone, used twice a day by 40 participants with arterial leg ulcers, for eight weeks or until healing, whichever was sooner. One compared topical application of blood-derived concentrated growth factor (CGF) with standard dressing (polyurethane film or foam); both applied weekly for six weeks by 61 participants with non-healing ulcers (venous, diabetic arterial, neuropathic, traumatic, or vasculitic). Both trials were small, reported results inadequately, and were of low methodological quality. Short follow-up times (six and eight weeks) meant it would be difficult to capture sufficient healing events to allow us to make comparisons between treatments. One trial demonstrated accelerated wound healing in the ketanserin group compared with the control group. In the trial that compared CGF with standard dressings, the number of participants with diabetic arterial ulcers were only reported in the CGF group (9/31), and the number of participants with diabetic arterial ulcers and their data were not reported separately for the standard dressing group. In the CGF group, 66.6% (6/9) of diabetic arterial ulcers showed more than a 50% decrease in ulcer size compared to 6.7% (2/30) of non-healing ulcers treated with standard dressing. We assessed this as very-low certainty evidence due to the small number of studies and arterial ulcer participants, inadequate reporting of methodology and data, and short follow-up period. Only one trial reported side effects (complications), stating that no participant experienced these during follow-up (six weeks, low-certainty evidence). It should also be noted that ketanserin is not licensed in all countries for use in humans. Neither study reported time to ulcer healing, patient satisfaction or quality of life. There is insufficient evidence to determine whether the choice of topical agent or dressing affects the healing of arterial leg ulcers.

1912 Chronic Non-Healing Gastric Ulcer Caused by Eosinophilic Gastroenteritis

INTRODUCTION: Eosinophilic gastroenteritis (EG) occurs when eosinophils (eos) infiltrate the gastrointestinal (GI) tract leading to GI dysfunction. The prevalence of EG is 2.5 cases per 100,000 people in the US. The diagnosis is confirmed by histology with &gt;20 eos per HPF. Common manifestations include abdominal pain, nausea, vomiting, and malabsorption. Ulcers are rarely seen in EG. CASE DESCRIPTION/METHODS: We describe a case of a 23 year old female with history of asthma presented with one month of severe epigastric pain, nausea and vomiting. Her pain was constant and exacerbated by eating. She took NSAIDs for 14 days without relief but denied melena, hematochezia, and hematemesis. She had no history of food intolerances, travel, smoking or alcohol use. Vitals and exam were unremarkable except for epigastric tenderness without rebound or guarding. Initial work up revealed WBC 8.0 K/UL with 16.7% eos, Hb 11.9 g/dL, MCV 80.6 fL, and ferritin 3 ng/mL. EGD revealed LA Grade A esophagitis, duodenitis, and a non-bleeding cratered antral ulcer, measuring 20 mm (Figure 1). Pathology revealed chronic gastritis without H. pylori. Pantoprazole 40 mg BID and sucralfate 1 g QID were initiated, but she continued to have symptoms and new onset hematemesis. Repeat EGD showed persistent 20 mm ulcer after 2 months of medical therapy. Biopsies showed marked eos in the esophagus, stomach, and duodenum, with &gt;50 eos/HPF at the ulcer (Figure 2). Biopsies from a colonoscopy done at the time same revealed increased eos at the ileocecal valve. A workup for eosinophilia was negative for autoimmune or parasitic etiologies, gastrin level was normal, but serum IgE level was 1862 IU/mL. She was treated with prednisone and repeat EGD 2 months later revealed resolution of mucosal eosinophilia and decrease in ulcer size to 10 mm. DISCUSSION: Our patient was found to have diffuse eosinophilic infiltration throughout the GI tract as well as significant peripheral eosinophilia. While the ulcer may have been initially caused by NSAID use, it was refractory to treatment due to eosinophilic inflammation. Only after initiation of corticosteroids, did it begin to heal. The primary management for EG is elimination diet and avoidance of triggers. Systemic corticosteroids are effective in controlling symptoms if dietary modification is unsuccessful. There is limited evidence for the use of other medications including antihistamine, leukotriene, or IgE antagonists. In patients with ulcers refractory to conventional therapies, EG should be considered.

Comparative evaluation of the efficacy of topical amlexanox 5% oral paste and triamcinolone acetonide 0.1% oral paste in the treatment of Recurrent Aphthous Stomatitis (RAS)

Background: A double-blind randomized control trial was conducted to compare the clinical efficacy of topical triamcinolone acetonide 0.1% and amlexanox 5% in recurrent apthous stomatitis (minor). Materials and Methods: Forty adult patients were assessed for erythema, ulcer size, pain scores, and ulcer healing on three evaluation visits within 24 h of ulcer formation, third day, and fifth day. All participants were monitored for compliance with treatment protocols of four times daily application of calibrated quantity of medication. Results and Discussion: Ninety percent of controls when compared with 65% of the participants in the amlexanox group showed complete improvement of peri-ulcer erythema. Pain reduction was marked from the first to the fifth day (F = 15.249, P = 0.000). The control participants showed 90% reduction in pain in comparison to 70% in the amlexanox group. The mean ulcer size was shown to reduce from the first to fifth day in both groups (F = 18.611, P = 0.000). Completely healed ulcers were seen in 70% of the participants in the control group compared with 75% of the participants in the amlexanox group. Conclusion: The data suggest that the clinical efficacy of topical amlexanox 5% is comparable to topical 0.1% triamcinolone acetonide and may be considered a substitute except in pain control, which was marginally less for the treatment for recurrent apthous stomatitis (minor).

Silver colloid dressings score over conventional dressings in diabetic foot ulcer: a randomized clinical trial

Background: Topical silver treatments and silver dressings are increasingly used for the local treatment of contaminated or infected wounds; however, there is a lack of clarity regarding the evidence for their effectiveness. To compare the outcome of silver colloidal based dressing in comparison to conventional dressing in management of diabetic foot ulcers.Methods: This was a single institution prospective randomized controlled trial. Patients with Wagner grade 1and 2 diabetic foot ulcer were enrolled in this study. Patients were assessed on day one and then at two weeks interval for twelve weeks for ulcer size by planimetry.Results: Out of 25 patients, 13 were randomized to silver colloid group and 12 in conventional dressing group. Age and sex distribution was comparable among two groups. Total 29 ulcers were present in silver colloidal and conventional dressing group. Mean wound area in silver colloidal dressing group and conventional dressing group on admission was 36.8 and 20.46 cm2 respectively. After 12 weeks of dressing mean wound area in silver colloidal dressing group and conventional dressing group decreased by 31.52 (85.65%) and 14.04 (68.62%) and after 12-week complete healing was seen in 11 (84.62%) patients in silver colloidal dressing group and 5 (41.67) patients in conventional dressing group.Conclusions: The results suggest that silver colloidal based dressing had significantly better outcome in form of complete healing and decrease in ulcer size in comparison to conventional dressing in diabetic foot ulcers (p value &lt;0.05).

Comparative study of safety and efficacy of omeprazole, lansoprazole, and rabeprazole in triple therapy for eradication of Helicobacter pylori in peptic ulcer patients in Indian population

Background: Triple therapy which includes a proton pump inhibitor (PPI) along with two antimicrobials is routinely used for the eradication of Helicobacter pylori. Multiple regimens are reported using different combinations of PPIs and antimicrobials. Aims and Objectives: The current study is done to compare the efficacy and safety of three PPIs omeprazole, lansoprazole, and rabeprazole in combination with amoxicillin and tinidazole. Materials and Methods: The patients were randomly assigned to receive one of the three regimens including one of the PPI with amoxicillin and tinidazole for 2 weeks followed by respective PPI once daily for 4 weeks. Follow-up visits were done at 2 and 6 weeks of the treatment. Endoscopy was done for any decrease in size of ulcer, rapid urease test, and histopathology for clearance of H. pylori. Results: There was a significant reduction in the size of ulcer at the end of 2 weeks in all the three groups and total healing of ulcer was observed in rabeprazole group when compared to omeprazole and lansoprazole groups. H. pylori eradication as per negative urea breath test was between 85% and 94% and it was highest in rabeprazole group. Conclusion: The three drugs were safe and equally effective in eradicating H. pylori, but rabeprazole showed earlier symptomatic relief with rapid eradication rate of H. pylori in peptic ulcer disease compared to omeprazole and lansoprazole, but it was not statistically significant. Hence, rabeprazole can be recommended to be used in PPI-triple therapy for cure of H. pylori infection in Indian population for earlier relief and better cure rates.

Abordagem terapêutica de úlcera venosa crônica por enfermeiro especialista: relato de experiência

A insuficiência venosa crônica dos membros inferiores causa incapacidade e representar importante problema de ordem socioeconômica, pode conduzir à invalidez, levando a piora na qualidade de vida. Relatar um caso clínico de tratamento domiciliar de úlcera venosa crônica . Descrição de caso clínico com avaliação inicial, conduta terapêutica e evolução, documentado com registro fotográfico e planimetria com o programa ImageTool®. Cliente E.B., 91 anos, deambulante com auxílio, apresentando lesão em membro inferior esquerdo há 50 anos. Na avaliação inicial apresentava duas úlceras venosas: no dorso do pé esquerdo com 16,36 cm2, e em região face medial lateral da perna esquerda com 50,27 cm2. Lesões crônicas e tecido de granulação com pontos de necrose e esfacelos. Aspecto sangrante e com biofilme. Exsudato com aspecto seropurulento, amarelado, moderada quantidade, ausência de odor. Queixa de dor intensa. O tratamento foi focado no controle da colonização e redução do exsudato, optando-se por faixa compressiva e curativo com prata nanocristalizada e debridamento instrumental conforme a necessidade. Após controle do exsudato, foi utilizado hidrogel com alginato de cálcio e papaína 3%. Em oito meses, houve redução no tamanho das úlceras em 47% da região face medial lateral da perna esquerda e 85% do dorso do pé e diminuição da dor. O enfermeiro especialista é fundamental no processo de avaliação da ferida para o desenvolvimento de um plano terapêutico que compreende adequação do cuidado tópico, uso de terapia compressiva e orientações ao paciente e seu cuidador.

Assessment of anti-bacterial activity of silver ions in infected diabetic foot ulcers – An answer to antibiotic resistance

Background: Easy accessibility and irrational use of antibiotics has led to emergence and spread of multidrug bacteria in nosocomial and community settings. MDR strains of Pseudomonas aeruginosa, Staphylococcus aureus and Enterobacteriaceae are commonly isolated from infected diabetic ulcers. Escalating antibiotic resistance has led us to reconsider use of heavy metals particularly silver which is known to reduce bacterial burden in infected wounds. This study aims to assess the bactericidal and clinical effect of silver alginate foam dressings on infected diabetic foot ulcers. Methods & Materials: Fifty cases of infected diabetic foot ulcers were studied. Quantitative bacterial cultures on sheep blood agar were performed as baseline (prior to treatment) and at 7 and 14 days following treatment with silver alginate dressing. Results of quantitative cultures were co-related with clinical improvement in ulcer size and local signs of infection. Bacteria isolated were identified and antibiogram was determined as per CLSI guidelines. Killing curves were recorded by inoculating the surface of silver alginate dressing with 105 bacteria. Sensitivity and duration of silver ion activity was assessed by disc diffusion method on nutrient agar using 7mm disc of silver dressing. Growth inhibition zone diameters were recorded by serial transfer of silver ion foam disc onto freshly inoculated plates for 7 consecutive days. Results: Bacteria isolated included S.aureus 32% (28% MRSA), E.coli 24% (39% ESBL producers, 12% MBL producers), P.aeruginosa 37% (15% MBL producers), Enterobacter spp 4% and Citrobacter 3%. Killing curves showed sterility approximately one to 2.5 hours following exposure to silver ions. All the isolates were sensitive to silver ions irrespective of their antibiotic resistance status. Growth inhibition zone diameters were maintained steady upto 7 days. In all cases decrease in bacterial load was associated with decrease in ulcer size. Conclusion: This study shows topical use of silver ions could serve as an effective alternative to topical or oral antibiotics in management of infected wounds. When used once weekly silver alginate foam dressing appears to be effective in reducing wound bio-burden which is positively associated with ulcer healing. Thus we can conclude that silver ions can be used effectively for treatment of chronic ulcers.

Autologous skin substitute for hard‐to‐heal ulcers: Retrospective analysis on safety, applicability, and efficacy in an outpatient and hospitalized setting

Chronic ulcers ((arterio)venous, decubitus, or postoperative) have no tendency to heal within a period of at least 3 months despite optimal therapy according to internationally accepted guidelines. This retrospective study evaluates the safety and efficacy of an autologous, dermal-epidermal skin substitute (SS) for treating ulcers of various origins. Ulcers were treated within 7 Dutch centers over 5 years. Sixty-six ulcers (size: 0.75-150 cm²; duration: 0.25-32 years) with a follow-up time of 24 weeks after a single-skin substitute application were assessed. Wound-bed preparation consisted of vacuum-assisted-closure-therapy (5 days, hospitalized) or application of acellular dermis (5-7 days, outpatient). Time to heal, adverse events, and recurrence 1 year after complete healing were recorded. Complete ulcer healing occurred in 36 of 66 ulcers (55%) at 24 weeks. At that time point, a further 29% of ulcers showed decrease in ulcer size between 50 and 99%. No difference was observed between the hospitalized vs. outpatient treatment with complete healing. There were 32 of 36 healed ulcers that were available for follow-up 1 year after complete closure, of which 27 (84%) were still closed. Only two minor/moderate possibly related adverse events were recorded. This retrospective analysis shows that SS provides a safe and successful treatment for particularly chronic ulcers of various origins.

Treatment of refractory venous stasis ulcers with autologous platelet-rich plasma and light-emitting diodes: a pilot study

Background: Stasis dermatitis with secondary ulcer formation is not only therapeutically challenging but also significantly decreases the quality of life for affected individuals. Recently, autologous platelet-rich plasma (PRP) has entered the therapeutic regimen for leg ulcers, while light-emitting diodes (LEDs) are now used to accelerate wound healing. Objective: To assess the efficacy and safety of autologous PRP with concomitant LED therapy for the treatment of venous stasis dermatitis with secondary ulceration. Methods and materials: In total, 16 Korean patients with ulcers secondary to venous stasis dermatitis were enrolled in this study. Each lesion was treated with autologous PRP weakly, and LED therapy three times per week. Treatments continued for 6 weeks or until the ulcer completely reepithelialized without evidence of drainage. Not only were subjects objectively evaluated by a study investigator, their own subjective satisfaction was also assessed. Results: The combined autologous PRP and LED therapy was well tolerated and safe. A statistically significant improvement was observed post-therapeutically in the clinical parameters of pain, itching, heaviness, paresthesia, cramps, and leg swelling. There was also a significant decrease in ulcer size. None of the patients showed worsening of their venous stasis ulcer. Regarding subject satisfaction with the regimen, 75.0% of participants reported being ‘satisfied or very satisfied' with their overall improvement after treatment. No significant adverse effects were observed. Conclusion: Combined autologous PRP and LED therapy is a promising conservative combination regimen for treating recalcitrant ulcerating stasis dermatitis. Additional studies comparing combined autologous PRP and LED therapy directly with autologous PRP or LED monotherapies are needed to confirm the results reported here.

A home‐based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study

This study aimed to assess the feasibility of a home-based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12-week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise programme. Further research is warranted with a larger multi-site study.

Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients

Objective We investigated the potential of a high-protein, arginine- and micronutrient-enriched oral nutritional supplement (ONS) to improve healing of pressure ulcers in non-malnourished patients who would usually not be considered for extra nutritional support. Methods Forty-three non-malnourished subjects with stage III or IV pressure ulcers were included in a multicountry, randomized, controlled, double-blind, parallel group trial. They were offered 200 mL of the specific ONS or a non-caloric control product three times per day, in addition to their regular diet and standard wound care, for a maximum of 8 wk. Results were compared with repeated-measures mixed models (RMMM), analysis of variance, or Fisher's exact tests for categorical parameters. Results Supplementation with the specific ONS accelerated pressure ulcer healing, indicated by a significantly different decrease in ulcer size compared with the control, over the period of 8 wk ( P ≤ 0.016, RMMM). The decrease in severity score (Pressure Ulcer Scale for Healing) in the supplemented group differed significantly ( P ≤ 0.033, RMMM) from the control. Moreover, significantly fewer dressings were required per week in the ONS group compared with the control ( P ≤ 0.045, RMMM) and less time was spent per week on changing the dressings ( P ≤ 0.022, RMMM). At the end of the study, blood vitamin C levels had significantly increased in the ONS group compared with the control ( P = 0.015, analysis of variance). Conclusion Specific nutritional supplementation accelerated healing of pressure ulcers and decreased wound care intensity in non-malnourished patients, which is likely to decrease overall costs of pressure ulcer treatment.

Lecithin-bound superoxide dismutase in the treatment of noninfectious corneal ulcers

PurposeTo evaluate the effects of a lipophilic analog of superoxide dismutase in the treatment of persistent epithelial defects of the cornea. DesignInterventional case series. MethodsNineteen eyes of 19 patients with noninfectious corneal ulcers were enrolled. Patient profiles consisted of seven cases with Mooren-type peripheral ulcers, three cases with chemical or thermal burns, two cases with vernal keratoconjunctivitis, four cases with cicatricial keratoconjunctivitis, and three cases with sterile ulcers after corneal surgery. Patients consisted of 11 men and 8 women, with a mean age of 51.5 ± 17.9 years (range, 14–77). Only patients who did not respond to conventional therapy were recruited for the study. Lecithinated superoxide dismutase was applied for 2 weeks, and sketches and/or fluorescein slit micrographs were recorded before and at the end of the study. The main outcome measure was decrease in ulcer size. ResultsAs a group, the average ulcer size relative to the entire cornea decreased from 18.2 ± 15.1% to 10.0 ± 15.0% after 2 weeks (P < .05). A dramatic effect (>90% decrease in ulcer size) was observed in eight cases (100% in six cases), whereas no apparent change was found (<30% decrease in ulcer size) in five cases. The presence of polymorphonucleocytes within the ulcerated tissue was confirmed by brush cytology. ConclusionLecinthinated superoxide dismutase was effective in decreasing persistent epithelial defect size in a subset of patients with sterile corneal ulcers refractive to conventional therapy. A large-scale clinical investigation is merited.

An open trial of calcium dobesilate in patients with venous ulcers and stasis dermatitis

Venous leg ulcers and associated stasis dermatitis are a major cause of morbidity, economic loss, and decreased quality of life in afflicted patients. Hence, there has been a renewal of interest in the medical management of varicose veins and ulcers. Calcium dobesilate, a capillotropic agent, has been found to be beneficial in the treatment of varicose veins. This is an open pilot study of 25 patients (15 with venous ulcers with/without stasis dermatitis, 10 with stasis dermatitis only) who were given calcium dobesilate, 500 mg twice daily, for 8 weeks. The clinical parameters were graded (0-4; 0, absent; 1, mild; 2, moderate; 3, severe; 4, very severe) both before and after therapy, and included pain, itching, tiredness, heaviness, paresthesia, cramps, and leg swelling. Evaluation also included subjective changes in tenderness, oozing, and pigmentation, and measurement of the circumference of the leg for swelling and malleolar edema (measured in millimeters). The venous ulcer sizes were also recorded both before and after therapy. Color Doppler studies were performed to confirm the diagnosis of varicose veins, determine the competence of the valves, and to rule out deep vein thrombosis. Serum biochemistry, hemogram, and urinalysis were performed both before and after treatment. The results were analyzed statistically using the Wilcoxon rank sum test and Student's t-test. A statistically significant improvement was observed post-therapeutically in the clinical parameters of pain, itching, tiredness, heaviness, and leg swelling. There was also a significant decrease in ulcer size. The serum biochemistry, hemogram, and urinalysis remained unaffected. Color Doppler studies before treatment revealed venous valvular incompetence in 20 patients. They were repeated in only 10 patients after treatment, four of whom showed improved valvular competence. Recurrence of venous ulcers was seen in five of 12 patients who were followed up after therapy. No significant side-effects were noted. Calcium dobesilate is an effective adjuvant therapy, with an absence of significant side-effects, in patients with venous ulcers and stasis dermatitis. More double-blind trials are required in the future to substantiate and evaluate the role of the drug in these two indications.

The Importance of Dietary Protein in Healing Pressure Ulcers

To determine the effect of dietary protein on healing of pressure ulcers in malnourished patients. Nutritional intervention trial with the non-randomized assignment of patients by pressure ulcer stage and bed type. Long-term care facility. Twenty-eight malnourished patients (age = 72 +/- 18 years, mean +/- SD) with a total of 33 truncal pressure ulcers. Nine patients had stage II ulcers, eight had stage III ulcers, and 16 had stage IV ulcers. Patients received liquid nutritional formulas as tubefeedings or meal supplements containing either 24% protein (61 g protein/L; n = 15) or 14% protein (37 g protein/L; n = 13) for 8 weeks. There was a significant decrease in total truncal pressure ulcer surface area of the 15 patients in the 24% protein group (-4.2 +/- 7.1 cm2, P < 0.02), but not in the 13 patients in the 14% protein group (-2.1 +/- 11.5 cm2, P = NS). The change in total ulcer area correlated with both dietary protein intake per kg body weight (rs = -0.50, P < 0.01) and caloric intake per kg body weight (rs = -0.41, P < 0.03). The decrease in stage IV ulcer area in eight patients in the 24% protein group (-7.6 +/- 5.8 cm2, P < 0.02) was significantly greater (P < 0.05) than in eight patients in the 14% protein group (-3.2 +/- 16.4, P = NS). In these 16 patients, the decrease in ulcer size also correlated with dietary protein intake per kg body weight (rs = -0.63, P < 0.01). High protein diets may improve the healing of pressure ulcers in malnourished nursing home patients.

Cimetidine and placebo in the treatment of benign gastric ulcer

Abstract A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14%. At 6 weeks the incidence of healing increased to 60% in the cimetidine group and 41% in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both the cimetidine and placebo groups, relatively liberal intake of a potent antacid occurred, despite recommendations that antacid be taken only for ulcer pain and a low reported frequency of ulcer pain throughout the study. The role of potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.

Cimetidine and placebo in the treatment of benign gastric ulcer: A multicenter double blind study

A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14%. At 6 weeks the incidence of healing increased to 60% in the cimetidine group and 41% in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both the cimetidine and placebo groups, relatively liberal intake of a potent antacid occurred, despite recommendations that antacid be taken only for ulcer pain and a low reported frequency of ulcer pain throughout the study. The role of potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.