Dermal Ulcers Research Articles

A Review of Winter Ulcer Disease and Skin Ulcer Outbreaks in Atlantic Salmon (Salmo salar)

Winter ulcer disease (WUD) is widely recognized as a serious threat to animal welfare and a major contributor to revenue loss within the aquaculture sector, particularly affecting the salmon-farming industry. This highlights the significant impact of WUD on both animal well-being and the economic sustainability of fish farming. WUD causes hemorrhagic signs and results in dermal lesions and ulcers. This disease can lead to higher mortality rates and a considerable decline in the fish’s market value. Moritella viscosa, a Gram-negative bacterium, is predominantly, but not exclusively, correlated with the emergence of WUD, mostly during the colder seasons. Waterborne transmission is the primary way for spreading the bacterium within a population. However, there is remarkable variation in the prevalence and characteristics of WUD in different regions. In Europe, this disease often occurs in the winter, and the intensity and occurrence of outbreaks are influenced by water temperature and salinity. In contrast, outbreaks are typically observed in the summer and mid-autumn in Eastern Canada. Despite the administration of various polyvalent vaccines, outbreaks of skin ulcers have been documented in Canada, and studies have highlighted the possible roles of other bacterial pathogens in Atlantic salmon. This review discusses the etiology, pathogenesis, and potential mitigation or prevention strategies for WUD, mainly in Atlantic salmon. Moreover, it underscores the necessity of conducting further investigations to discover the potential unknown causative agents of ulcerative disease and design appropriate vaccines or preventive strategies for these pathogens.

Infection of Achlya sp. associated with dermal ulceration and mortality in an endemic snakehead fish Channa aurantimaculata

Infection of Achlya sp. associated with dermal ulceration and mortality in an endemic snakehead fish Channa aurantimaculata

Isolation, Identification, and Pathogenicity of Vibrio gigantis Retrieved from European Seabass (Dicentrarchus labrax) Farmed in Türkiye.

In this study, V. gigantis strain C24 was isolated from cases of winter mortalities of hatchery-reared European seabass (Dicentrarchus labrax) broodstock in Türkiye. The first mortalities were reported in September 2016 and occurred annually in early autumn/late winter until the end of February 2019, when 15% of accumulated mortality was recorded. Diseased moribund fish exhibited general septicemic signs, including dermal ulcerations with hemorrhagic margins, distended abdomens, and hemorrhages below the pectorals, pelvic fins, and at the operculum. Postmortem findings showed congestion in several internal organs, hemorrhagic ascitic fluid, and congested prolapsed anal openings. The representative bacterial isolate V. gigantis strain C24 was characterized as Gram-negative, motile, nitrite-producing, and as vibrio static agent O/129-sensitive. The full-length 16S rRNA sequence (Accession No. ON778781) and gyrB gene sequence (Accession No. ON792326) of the C24 strain showed high similarity to V. gigantis strains. Moreover, the whole-genome average nucleotide identity (ANI) values (ANI > 97.7%) against four V. gigantis strains above the species demarcation limit unambiguously identified the C24 isolate as a member of this species. A preliminary virulence-gene analysis showed that the V. gigantis isolate C24 encoded at least three exotoxins, including two aerolysins and a thermolabile hemolysin. The experimental infection showed that the C24 isolate exhibited low to moderate virulence in experimentally infected European seabass juveniles. Interestingly, antimicrobial susceptibility testing revealed that the C24 isolate was susceptible to nalidixic acid, ciprofloxacin, and several other antibiotics but resistant to tilmicosin, kanamycin, streptomycin, and ampicillin. To our knowledge, this study is the first to report that V. gigantis could be considered an emerging bacterial pathogen in Türkiye, and it may threaten the international European seabass production.

Treatment of dermal ulcer with autologous fibrin glue: Two case reports of an exploratory prospective pilot study.

The healing of recurrent and refractory skin ulcers requires a long time, during which there is risk of infection, and hospital admission is occasionally required for surgical or daily conservative treatment. Therefore, the development of promising treatments that promote faster, uneventful healing is a must. Composed of cryoprecipitate and thrombin, fibrin glue has a history of surgical use for preventing bleeding and spinal fluid leakage. Moreover, in-house cryoprecipitates contain higher concentrations of coagulation factors and cytokines that may enhance wound healing than commercially available products. However, the efficacy of completely autologous fibrin glue (AFG) in tissue repair has not yet been fully demonstrated. This study aimed to evaluate the efficacy of AFG in the treatment of refractory skin ulcers in comparison with the conventional treatment. Two patients with skin ulcer on their lower extremities due to trauma or scleroderma who showed resistance to conventional treatment were included in the study. Both study participants were diagnosed with refractory skin ulcer and were ineligible for autologous skin transplantation. AFG was prepared following autologous blood donation using a Cryoseal® system. Subsequently, AFG was administered to 50% of the area of each ulcer and observed for 4 weeks in comparison with recombinant basic fibroblast growth factor with bucladesine sodium treatment that was administered to the rest of the ulcer. The skin ulcer after trauma in participant 1 showed better improvement in the AFG-treated area. Although AFG did not show superiority regarding the ulcer area of a patient with scleroderma, it guarded the continuous exudation from the edge of the swollen skin surrounding the ulcer. AFG showed effective and beneficial results for wound healing of refractory skin ulcer and prevented exudation without any severe adverse events.

Interdisciplinary approach to solve unusual mortalities in the European common frog (Rana temporaria) in two high-mountain ponds affected by climate change

The global decline in amphibian populations is a major environmental issue. Chytridiomycosis, Ranaviruses and the red-leg syndrome have been identified in unusual mortality events. However, these infections do not account for all causes of declining amphibian populations. Moreover, several cases of amphibian mortality are difficult to solve without resorting to an interdisciplinary approach. Two cases of unusual mortality in Rana temporaria occurred at two high-mountain ponds (northwest Italy) in April and May 2021. Water and frog samples were analysed to understand the possible causes responsible for the unusual mortalities. Results of the main physicochemical (pH, conductivity, dissolved oxygen, chemical and biochemical oxygen demand) and nutrient (ammonia/ammonium, nitrite, nitrate, total phosphorus) parameters revealed a good condition of the water quality, with the absence of the main cyanotoxins (microcystins/nodularins). However, unseasonably high spring water temperatures were recorded in both ponds (12.73 °C and 14.21 °C for Frog Pond and Selleries Pond, respectively). Frogs (n = 50; snout–vent length: 7.0–9.8 cm; body mass: 85–123 g) collected from Frog Pond mainly presented bumps on the ventral cavity and dermal ulceration associated with the isolation of Carnobacterium maltaromaticum. On the other hand, frogs (n = 5; snout–vent length: 8.0–9.1 cm; body mass: 87–92 g) from Selleries Pond presented petechiae and dermal ulcerations on the rear limbs associated with the isolation of Aeromonas salmonicida and A. sobria. In both mortality events, the interdisciplinary approach revealed an association between frog mortalities and the isolation of bacteria. Isolated bacteria are considered opportunistic pathogens, and the high values of the water temperature has certainly led a stress on the frogs, favouring the spread of bacteria and the death of the frogs. Further studies are needed to assess the pathophysiological effects of the opportunistic bacteria here isolated, clarifying the interactions between emerging pathogens and climate change.

Histopathological findings in a pilot study of dairy calves disbudded with hot cauterization or caustic paste

We describe the histological tissue damage and compare the healing process in 16 dairy calves disbudded at a mean age of 6 days by cauterization or alkaline caustic paste application. Biopsies were taken 2 days (T2) and 2 weeks (T14) after disbudding from sedated calves treated with local anaesthetic and non-steroidal anti-inflammatory drugs. At T2, the cauterized horn buds generally had eosinophilic coagulative necrosis of the epidermis and superficial dermis, bordered basally by a neutrophilic demarcation zone. Lateral to the direct heat contact area, dermal blood vessels were thrombosed, with wall damage and perivascular neutrophils. In the caustic paste-treated horn buds, the epidermis and dermis had diffuse full-thickness liquefactive necrosis directly under the paste contact area. The necrosis spread laterally in the dermis beyond the area of paste contact and was bordered by a neutrophilic infiltrate. At T14, the cauterized horn buds had epidermal to superficial dermal ulceration and crusting, dermal neutrophilic infiltration and granulation tissue formation. In contrast, most of the caustic paste-treated horn buds consisted of a superficial dermal crust or predominantly necrotic tissue fragments. The remaining viable areas had histiocytic inflammation with peripheral neutrophils and early granulation tissue formation. Caustic paste disbudding caused poorly demarcated lesions that were more severe and extensive and took longer to heal than those due to cautery. Cauterization induced a more intense acute reaction adjacent to the primary lesion compared with caustic paste.

Comparison of Soluble and Liposome Encapsulated, Sustained Release Latanoprost for Focal Adipose Reduction.

Background: To address the lack of non-cytotoxic, non-surgical options to treat undesirable focal adiposity of the face, we propose use of the anti-glaucoma medication and prostaglandin F2α analogue latanoprost, which has a well-described side effect of periorbital adipose shrinkage. Objective: To evaluate the safety and efficacy of soluble and liposomal latanoprost for focal fat reduction. Approach: To compare efficacy, single administrations of either the FDA-approved cytolytic drug deoxycholic acid (DOCA), latanoprost, or liposomal latanoprost were injected into ob/ob mouse inguinal fat pads. Study outcomes included mouse weight, inguinal fat pad volume, architecture, and cytotoxicity. Results: Both DOCA and soluble latanoprost significantly reduced inguinal fat pad volume whereas liposome encapsulation reduced inguinal fat pad volume insignificantly over the 14-day study period. Hematoxylin and eosin demonstrated effective reduction in adipocyte volume without histologic evidence of cytolysis or inflammation whereas DOCA caused dermal ulcerations, adipocyte lysis, and increased tissue inflammation. Conclusion: Latanoprost reduced fat volume without inducing cell lysis or inflammation.

Dactylogyrus extensus and Pseudomonas fluorescens dual infection in farmed common carp (Cyprinuscarpio)

Dactylogyrus extensus and Pseudomonas fluorescens are serious pathogens in Cyprinus carpio aquaculture causing severe impacts and substantial economic losses. During the early spring of 2021, abnormal mortalities were reported among farmed C. carpio. Moribund fish showed anorexia, respiratory distress, dermal ulcers, and septicemia. The water analysis revealed low dissolved oxygen (3.4 mg/L), and high un-ionized ammonia levels (0.65 mg/L). Seventy moribund C. carpio specimens were collected and subjected to parasitological and bacteriological examinations. The monogenetic trematode D. extensus was discovered in wet mounts from the gills of all the examined fish samples (100%). The identity of recovered parasites was confirmed by sequencing and alignment of the 28S rDNA gene. P. fluorescens was concurrently identified in the infested fish samples (58.5%) based on phenotypic characteristics using the API20 E. The identity of bacterial isolates was confirmed further by sequencing and alignment of 16S rRNA gene. The IL-1β and MHCII were upregulated in infested fish in tandem with the severity of infections. P. fluorescens isolates displayed high resistance to most of the tested antibiotics. The study is one of the earlier reports on D. extensus and P. fluorescens co-infections in farmed C. carpio and highlights the need of effective control programs to protect fish health and minimize losses.

Abstract 560: Generation of tertiary lymphoid structures and CD3+ CD8+ CD56+ NKG2D+ CAR TaNK cells following subcutaneous injection of CD3-directed lentiviral-loaded PBMCs

Abstract Background: We have previously established the ability of CD3-directed lentiviral vectors encoding for CD19 or CD22 CARs to mediate robust anti-tumor immunity in humanized lymphoreplete mouse models. We now present additional mechanistic data for this novel subcutaneous (SC) CAR-T approach. Methods: Human PBMCs loaded with a self-inactivating lentiviral vector (LV) encoding CD19 CAR with a synthetic driver element were injected SC into autologous PBMC humanized NSG MHC I/II double knock out (DKO) mice. The LV was packaged with a modified envelope with the ability to target and activate CD3+ T cells. To first track the site of CAR formation in vivo following SC injection, PBMCs were loaded with an LV encoding a CD19 CAR and luciferase, and bioluminescence imaging (BLI) was performed. Additionally, histopathology of the site of injection and distal organs were examined. Evaluation for CAR+ cells was performed through immunohistochemistry and PCR detection. To examine the tropism of the CD3-directed CD19 CAR LV and characterize CAR+ cells, the phenotype of in vivo expanded CAR+ cells was evaluated. Further characterization of CAR+ cells was performed with in vitro studies. Results: Following SC injection of LV-loaded PBMCs, the first evidence of transgene expression utilizing BLI for luciferase was detected four to five days following SC injection. At the same time point, histologic examination of the SC site of injection revealed the formation of tertiary lymphoid structures (TLS) consisting of human CD8+ and CD4+ T cells, CD68+ macrophages, CD68+ dendritic cells, and a few CD20+ B cells. On day 13 post-SC injection, BLI detected the presence of CAR+ cells systemically beyond the site of injection and within subcutaneous Raji tumors implanted on the contralateral side. On day 14 post-SC injection, histologic examination showed sustained TLS within the SC tissue without signs of dermal acute inflammation or ulceration and evidence of CAR+ cells appearing in the spleen. CAR+ cells exhibited robust anti-tumor immunity with expansion into peripheral blood. CAR+ cells consisted of a distinct population of CD8+ T cells with NK-like features (TaNKs) and a CD3+ CD8+ CD56+ NKG2D+ cell phenotype. In vitro transduction of CD56 NK cell-depleted PBMC with the CD3-directed LV also led to CAR-TaNK formation. Conclusion: The subcutaneous injection of CD3-directed LV-loaded PBMCs leads to the formation of tertiary lymphoid structures at the site of injection and the development of distinct CD3+ CD8+ CD56+ NKG2D+ CAR-TaNK cells. These cells possess enhanced systemic proliferative capacity compared to traditional ex vivo manufactured 41BB CAR-T cells in a lymphoreplete mouse model and the ability to eliminate target cells in vivo with low numbers of starting cells (10,000 cells). Citation Format: Ani Kundu, Dongming Zhang, Frederic Vigant, Junyi Zhang, Greg Schreiber, Ewa Jaruga-Killeen, Alissa Kerner, Michelle Andraza, Wei Zhang, John Henkelman, Renata Soares, Gregory I. Frost, Sid P. Kerkar. Generation of tertiary lymphoid structures and CD3+ CD8+ CD56+ NKG2D+ CAR TaNK cells following subcutaneous injection of CD3-directed lentiviral-loaded PBMCs [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 560.

Clinico-pathological findings and expression of inflammatory cytokines, apoptosis, and oxidative stress-related genes draw mechanistic insights in Nile tilapia reared under ammonia-N exposure and Aeromonas hydrophila challenge

Fish diseases have a “stress-related” nature, whereas fish exposure to stressors will increase their susceptibility to infections. It was also noted that fish exposure to biotic and abiotic stressors would exaggerate the disease signs, elicit high mortalities, and cause severe economic losses. Motile aeromonad septicemia (MAS) is a major bacterial disease affecting a variety of finfish species throughout the globe and is caused by Aeromonas hydrophila. Herein, we have evaluated the impacts of ammonia-N stress and/or Nile tilapia challenge with pathogenic A. hydrophila on the clinical picture of MAS disease. Clinical signs, postmortem lesions, histoarchitectural changes, and gene transcription analysis were studied. Fish experimentally infected with A. hydrophila were exophthalmic and showed darkened skin. Moreover, opercular hyperemia, petechial hemorrhages, and gill congestion alongside dermal ulcerations were noticed in ammonia-exposed fish. On the other side, fish exposed to both stressors exhibited exophthalmia, corneal opacity, severe dropsy, and hemorrhagic dermal ulcerations. At the tissue levels, the histopathological lesions were exaggerated in the fish group exposed to ammonia stress and challenged with A. hydrophila than fish group exposed to each one alone. At the molecular levels, the mRNA expression analysis reveals significant upregulation of inflammatory cytokines such as interleukin-1 beta, CXC chemokine, and tumor necrosis factor-alpha in the kidney tissues of Nile tilapia exposed to ammonia and/or challenged with A. hydrophila. In a similar trend, the mRNA expression values of heat shock protein 70 (HSP70), oxidative stress related genes (SOD and CAT) and apoptosis-related genes (caspase 3, BAX, and cytochrome P450) were also increased in the hepatic tissues of fish exposed to singular or dual stressors. Interestingly, the highest expression levels of the above-mentioned genes were found in the fish group exposed to both stressors. Taken together, these findings indicate the occurrence of severe inflammatory and apoptotic changes in fish exposed to ammonia and infected with A. hydrophila more than each one alone. In contrast, there was a significant decrease in the expression values of the antioxidant enzyme glutathione-S-transferase (GST) in stressed fish, suggesting the occurrence of oxidative stress. This study will be helpful to draw mechanistic insights into the exposure of fish to ammonia stress and infection with A. hydrophila.

Detection of some CC Chemokine Ligands in Patients with Cutaneous Leishmaniasis

Cutaneous leishmaniasis (CL) is an endemic parasitic disease found in many provinces of Iraq. The immune system plays a crucial role in the development or healing of lesions through chemotactic cytokine activity. This study was aimed to detect the levels of two chemokine ligands (CCL2 and CCL5) in Iraqi patients suffering from dermal ulcers, caused by cutaneous leishmaniasis. It was measured in pre and post-treatment state of Pentostam (Pentavalent Antimony 100 mg). Blood serum concentrations of CCL2, CCL5 were measured by enzyme-linked immunosorbent assay among newly infected patients, two-trial treatment patients and three-trial treatment patients, in comparison with the control group. The result indicated a significant difference in CCL5 level for the three groups of CL patients. Whereas the control (p˂0.5), CCL2 level counterparts showed a significant difference only in newly infected and the thee-trial treatment groups. Moreover, there was a significant difference between all CCL5 patient groups, while no observed difference was detected within patient groups of CCL2.Thus altering the chemokine levels before and after treatment gives insights for parasite role in chemokine expression which may help in new therapeutic approaches for dry or wet CL.

Establishment of different challenge models for Aeromonas salmonicida subsp. achromogenes in turbot and sole

Aeromonas salmonicida subsp. achromogenes is one of the causative agents of “atypical furunculosis”, characterized by the presence of dermal ulcerations and external pathology with or without subsequent septicaemia. This study was aimed to identify possible routes of infection of A. salmonicida subsp. achromogenes in turbot (Scophthalmus maximus) and sole (Solea senegalensis). Thus, challenge tests were performed using four different infection routes: intraperitoneal (ip), and subcutaneous (sc) injection, immersion (im) and intragastric (ig) inoculation. Among the inoculation routes tested ip and sc injection and im caused mortality and reproduced the clinical signs of the furunculosis in the experimentally infected fish. The strains of A. salmonicida subsp. achromogenes used in this study showed no host specificity, being capable of infecting turbot and sole in experimental conditions reaching 80–100% of mortality after ip and sc inoculation. A. salmonicida subsp. achromogenes was confirmed as the causative agent of mortalities by culture and qPCR analysis of samples from moribund or dead fish. Further studies are needed to identify route of entry and dissemination of A. salmonicida subsp. achromogenes in fish which will help to improve treatment and prophylactic strategies.

Dermoscopic spectrum of mycosis fungoides: a retrospective observational study by the International Dermoscopy Society.

The dermoscopic features of classic patch stage mycosis fungoides (MF) have been described, but data on plaque and tumoral stage as well as rarer MF subtypes is limited. To evaluate dermoscopic morphology and dermoscopic-pathological correlations of classic MF stages and investigate dermoscopic features of MF variants. Patients with histopathologically confirmed lesions of classic MF (patch, plaque and tumoral stage) or folliculotropic, erythrodermic and poikilodermatous MF were included. Standardized evaluation of dermoscopic pictures of the included MF variants and comparative analysis and dermoscopic-pathological correlation assessment of different stages of classic MF were performed. A total of 118 instances were included (75 classic MF, 26 folliculotropic MF, 9 erythrodermic MF and 8 poikilodermatous MF). Linear/linear-curved vessels and white scales in the skin furrows were significantly associated with patch-stage MF, while clustered dotted vessels were related to plaque-stage MF and peripheral linear vessels with branches, ulceration and red globules separated by white lines to tumour-stage MF. Moreover, patchy white scales were significantly more common in patches and plaques compared to tumours, whereas focal bright white structureless areas were related to plaque and tumoral stage. Vessels histopathologically corresponded to dilated vascular structures in the dermis, orange structureless areas to either dermal hemosiderin (patch/plaque stage) or dense cellular infiltration (tumours), bright white lines/structureless areas to dermal fibrosis and ulceration to loss of epidermis. The main dermoscopic findings of folliculotropic MF were lack of hairs, dilated follicles and follicular plugs, while erythrodermic MF was mainly characterized by linear/dotted vessels, patchy white scales and focal orange structureless areas and poikilodermatous MF by focal white and brown structureless areas, white patchy scales and brown reticular lines. Dermoscopy may allow a more precise characterization of classic MF and reveal clues suggestive of the main MF variants.

Anterolateral thigh flaps in closing large abdominal wall defect after the resection of mucinous adenocarcinoma: a case report

BackgroundIt is a big challenge to repair a large abdominal wall defect after tumor resection, and en bloc resection with vascularized tissue reconstruction might be an alternative to achieve an improved survival for abdominal wall tumors.Case presentationA 45-year-old woman presented with a 1-year history of persistent abdominal pain of the right lower quadrant and a mass with dermal ulceration. An enhanced computed tomography scan and biopsy of the mass were performed to achieve the definite diagnosis of abdominal mucinous adenocarcinoma. After four courses of “FOLFOX” chemotherapy, the tumor grew to 6 × 5 cm during preoperative examination. Thereafter, we removed the tumor and involved tissues and organs and repaired the sizeable abdominal wall defect used by biological meshes and vascularized anterolateral thigh flaps. The patient suffered green drainage of 450 ml in the abdominal cavity and intestinal anastomotic fistula, for which she readmitted and recovered afterward.ConclusionsBiological mesh combined with vascularized anterolateral thigh flaps could effectively repair the large abdominal wall defect and restore the biological function of the abdominal wall.

Pharmacological Mechanisms of Shangke Huangshui against Skin and Soft Tissue Infection.

Background Skin and soft tissue infections (SSTIs) are a group of common diseases, usually caused by bacteria. Shangke Huangshui (SK) has been widely used to treat various SSTIs diseases for many years, but its mechanism is unclear. Therefore, this study was designed to investigate the anti-infective effect of SK on different skin and soft tissue infection diseases and to explore its underlying mechanism. Methods The subcutaneous abscess mouse model, the dermal ulcer rat model, and the infectious soft tissue injury rat model were established by injection of Staphylococcus aureus to evaluate the anti-inflammatory and antibacterial effects of SK. Abscess volume, local appearance score and histological changes, bacterial contents, and hydroxyproline concentration in the skin or soft tissue were analyzed. The levels of NO, TNF-α, IL-1β, and IL-8 in the serum and tissue were determined by ELISA method. The mRNA expression levels of TLR2, MyD88, TAK1, NF-κB, AP-1, and other genes were measured with qRT-PCR method, and the protein expression of TLR2, MyD88, TAK1, NF-κB, and AP-1 was detected by western blot method. Results SK had an obvious therapeutic effect on skin and soft tissue infections. It reduced the volume of abscess and promoted the healing of skin ulcer, improved pathological phenomena, such as inflammatory infiltration of skin and soft tissue, reduced the levels of white blood cells and NO in the blood, decreased bacteria contents in the skin and soft tissue. Furthermore, SK decreased the mRNA expression of TLR2, MyD88, TAK1, NF-κB and AP-1, and other related genes and also downregulated the protein expression of TLR2, MyD88, TAK1, NF-κB, and AP-1. Conclusion The experiments provide evidence that SK can treat skin and soft tissue infection diseases based on its comprehensive antibacterial and anti-inflammatory effects. The therapeutic mechanism may be associated with the inhibition of TLR2/MyD88/NF-κB signaling pathway.

Plasma rich in growth factors (PRGF ‐ENDORET®) to rescue necrotized orbital dermis‐fat grafts

AbstractPurposeTo report the clinical course of three patients treated with topical plasma rich in growth factors (PRGF) to rescue Dermal‐fat grafts (DFG) with graft ulceration (GU).MethodsRetrospective, case‐series study of three patients diagnosed with GU in DFG and treated with PRGF. Drops were applied 4 times per day and treatment was maintained until the GU resolved. Data were collected from medical records and anterior segment photos.ResultsAll patients showed a favorable response to topical PRGF having accomplished full resolution of the GU within a mean of 30 days of treatment (range: 21–35 days). During the full extent of follow‐up, no side‐effects, signs of rejection or necrosis were reported and every patient was pleased with the final aesthetic result.ConclusionsOur results suggest that PRGF could be an effective treatment for dermal graft ulceration in patients who underwent DFG surgery/implantation, mainly due to its low morbidity when compared to traditional procedures.

Plasma rich in growth factors (PRGF -ENDORET®) to rescue necrotized orbital dermis-fat grafts

ABSTRACT Purpose We report on the clinical course of three patients treated with topical plasma rich in growth factors (PRGF) to rescue dermal-fat grafts (DFG) with graft ulceration (GU). Materials and Methods A retrospective, case-series study of three patients diagnosed with GU in DFG and treated with PRGF. Drops were applied four times per day and treatment was maintained until the GU resolved. Data were collected from medical records and anterior segment photos. Results All patients showed a favorable response to topical PRGF having accomplished full resolution of the GU within a mean of 30 days of treatment (range: 21–35 days). During the full extent of follow-up, no side-effects, signs of rejection or necrosis were reported and every patient was pleased with the final aesthetic result. Conclusion Our results suggest that PRGF could be an effective treatment for dermal graft ulceration in patients who underwent DFG surgery/implantation, mainly due to its low morbidity when compared to traditional procedures.

Isolation and characterisation of a novel rhabdovirus from snakehead fish showing surface ulcerations and mortality from India: First report

A novel viral agent was isolated from striped snakehead (Channa striata Bloch, 1793) suffering from mortality with dermal ulcerations and haemorrhagic areas in South India. The virus growth was well supported in striped snakehead (SSN-1) and sea bass caudal peduncle (SBCP2a) cell lines at 27 °C while EPC cells were refractory to the virus. Transmission electron microscopy of the infected cells revealed bullet shaped virions with the size ranging from 150 to190 nm length and 46 to 60 nm width. RT-PCR targeting block III fragment of the rhabdovirus L polymerase gene amplified an expected genomic portion of 483 bp. Phylogenetic analysis indicated 91% homology to the equivalent region of the reported snakehead rhabdovirus L polymerase. Experimental infection studies using cell culture grown virus induced 100% morality in juvenile snakehead in five days. Fish showed listlessness, neural pathology and lethargy before dying. Clinical signs included haemorrhages at the fin bases, exophthalmia, darkening of the skin, vascular congestion around the eyes and reddish iris and surface ulcers. The virus caused extensive necrosis of kidney, spleen and liver. The clinical pathology along with the morphology and phylogenetic homogeneity indicates that the virus belongs to the genus Novirhabdovirus under the family Rhabdoviridae. The present study forms the first report of isolation of a fish rhabdovirus in India.

Molecular Study of Cutaneous Leishmaniasis Species among Soldiers with Dermal Ulcers in Zahedan, Iran

Molecular Study of Cutaneous Leishmaniasis Species among Soldiers with Dermal Ulcers in Zahedan, Iran

Morphine Versus Loperamide with Intrasite Gel in the Treatment of Painful Dermal Ulcers: A Randomized, Crossover Study

BACKGROUND: Topical morphine along with intrasite gel has been proven to be a simple and effective method to relieve pain. However, morphine is still not freely available in developing countries due to drug restrictions and stringent laws governing it. Loperamide has been reported to relieve pain caused by stomatitis effectively when given topically. Loperamide, being an mu receptor agonist with no systemic absorption, can serve a dual purpose here. Also loperamide being freely available as an over-the-counter drug can be a surrogate drug for topical application. OBJECTIVES: The primary aim was to compare the efficacy of loperamide and morphine in treating pain when applied topically along with intrasite gel. STUDY DESIGN: Adult patients with healthy wounds with pain on Numeric Rating Scale (NRS-11) greater than 5 with no systemic comorbid illness were divided randomly into 2 groups – group morphine or group loperamide – for 24 hours followed by a 1-day washout and crossover in the other group for 24 hours. Pain was assessed once every day. SETTING: Medical college and hospital. METHODS: The parameters assessed included: (1) characteristics of the ulcer; (2) pain was assessed by NRS-11 at 12-hour intervals for a period of 72 hours; and (3) patient satisfaction. Statistical analysis used repeated measures analysis of variance to measure change in mean NRS-11 within each group. Analysis of covariance was used to compare the mean change in NRS-11 in the 2 groups. RESULTS: Morphine and loperamide were equivocal in pain relief after 12 and 24 hours (P = 0.400 and P = 0.753); however, the patient satisfaction scores were better in the morphine group. LIMITATIONS: The earlier studies performed used injectable forms of morphine, for the sake of comparison, we used powdered morphine and powdered Loperamide diluted with saline. Confounding variables include ulcer size and aetiology, which can be a source of bias. The ulcer size was not standardized due to the paucity of sample to study. Equianalgesic doses of loperamide and morphine could not be found even after an extensive literature search. The loperamide dose used in our case was equal to the dose used orally since the same dose appears effective across a range of oral opioid analgesics. The morphine dose was standardized as 10 mg based on a mixture previously used to treat pain due to epidermolysis bullosa. CONCLUSIONS: Topical loperamide can be an efficacious and novel intervention to treat painful ulcers while avoiding systemic effects. KEY WORDS: Loperamide, morphine, painful ulcer