Diabetic Ulcers Research Articles

Comparison between Ketogenic and Diabetic Conventional Diet on Wound Closure in Diabetic Rat Model

Background: Managing diabetic ulcers should be multimodal; nutrition is one of the modalities to improve wound healing. This study therefore aimed to compare ketogenic diet and conventional diabetic diet in closing the wounds of diabetic rat models.Methods: Diabetes mellitus was induced in 30 rats which were divided equally into three groups. Group I was given a ketogenic diet (60% fat, 24% carbohydrate, and 16% protein). Group II was given a conventional diabetic diet (43% carbohydrate, 15% fat, and 42% protein). Group III was the control group with a normal diet (13% water, 18.5%–20.5% protein, fat ≥4%, fiber ≤6%, ash ≤8%, 0.9% calcium, and 0.7% phosphor). A 1 cm-diameter wound was made with the Mason-Walker model as a guideline. The rate of wound closure was measured on days 1, 7, 14, and 21 to represent each wound healing phase.Results: On day 7, comparison between wound areas in the ketogenic diet, conventional diet, and normal diet yielded significant differences (mean, 0.664, 0.717, 0.747; P=0.051). There was also a significant difference on day 14 (mean, 0.564, 0.817, 0.647; P<0.001) and day 21 (mean, 0.164, 0.517, 0.447; P<0.001).Conclusion: Compared to a conventional diabetic diet, a ketogenic diet significantly enhanced the wound closure rate in the diabetic rat model. Further studies are needed to confirm this finding.

Investigating the Impact of Surfactant and Cosolvent on the Polyphenolic Content in Arumanis Mango Leaf Extract (Mangifera indica L.)

The leaf of Mangifera indica L. contains flavonoids and mangiferin which showed positive effects on wound healing of diabetic ulcer. The used of suitable surfactant and co-solvent is required to ensure the high solubility of the active pharmaceutical ingredient (API), thereby optimizing the efficacy. This study aims to determine the ideal surfactant and cosolvent for a thermosensitive hydrogel formula of Mangifera indica leaf ethanol extract. The leaf was fextracted by maceration using 70% ethanol then determined for moisture content. The extract was prepared for solubility tests of flavonoid and mangiferin on surfactants (Kolliphor® EL, Tween® 20, Tween® 80, Miranol® C2M) and co-solvents (Glycerin, PEG 400, and transcutol). Methods for total flavonoids content were Spectrophotometry UV-Vis and mangiferin with RP-HPLC method. The moisture content in the extract is 8.590 ± 0.754%. The surfactant demonstrating the highest capability in flavonoid dissolution is Tween 20 (1863.750 ± 0.838 µgQE/g extract), followed by Tween 80, Kolliphor EL, and Miranol C2M. In the context of co-solvents, PEG 400 (1309.583 ± 0.292 µgQE/g extract) show superior flavonoid dissolution capability, with glycerin and Transcutol following in descending order. Tween 20 and Tween 80 exhibite comparable efficacy in mangiferin dissolution, followed by Miranol C2M and Kolliphor EL. Among co-solvents, Transcutol demonstrate the highest aptitude for mangiferin dissolution, succeeded by PEG 400 and glycerin. This study indicates Tween 20 is a preferable surfactant and PEG 400 was considered as co-solvent to be further used in a thermosensitive gel formula for diabetic ulcer.Â

Common pathogens associated with infected diabetic foot ulcers: A retrospective cohort study in a specialized medical center in Jeddah, Saudi Arabia.

Foot infections, a frequent complication of diabetes mellitus, are associated with heavy resource utilization, including antibiotic therapy and surgeries. However, the most common type of isolated pathogen in diabetic foot infections remains unknown. We aimed to identify the most common types of isolated pathogens in diabetic foot infections. This retrospective cohort study was conducted in a specialized medical center in Jeddah, Saudi Arabia. A total of 96 patients diagnosed with diabetes and presented with a foot ulcer showing clinical signs of infection were included. The mean age was 63.03 ± 10.88 years, and 67.7% were males. The mean duration of diabetes diagnosis was 21.86 ± 9.66 years, and the majority had foot ulcers for over six weeks. Bacteria were present in 65 patients (67.7%), Gram-negative organisms were observed in 37 patients (38.5%), and Gram-positive organisms were present in 28 patients (29.2%). In the 65 patients with bacterial culture, Staphylococcus aureus was the most common isolated organism and was observed in 18 patients (27.7%), followed by Escherichia coli in 11 (16.9%) and Pseudomonas aeruginosa in 10 (15.4%). Binary regression analyses found that Gram-negative organisms were significantly more multidrug-resistant than Gram-positive organisms (P = 0.012, OR = 7.172, 95% CI = 1.542-33.352). Patient outcomes included healed ulcers (n = 10, 10.4%), minor amputation (n = 16, 16.7%), major amputation (n = 1, 1%), and debridement (n = 48, 50%). Gram-negative organisms were predominant in patients with diabetes and foot ulcers having clinical signs of infection. Treatment with an individualized antibiotic regimen is vital in ensuring optimal outcomes and preventing major amputations.

The Effectiveness of The Nursing Care Approach in Healing Diabetic Ulcers: A Case Study of Mrs. F in Sintuwulemba Village, Lage District, Poso Regency, Central Sulawesi Province

The Effectiveness of The Nursing Care Approach in Healing Diabetic Ulcers: A Case Study of Mrs. F in Sintuwulemba Village, Lage District, Poso Regency, Central Sulawesi Province

Gambaran Profil Lipid Pasien Diabetes Melitus Tipe 2

The prevalence of diabetes mellitus (DM) continues to increase and is even predicted to continue to increase, as does Indonesia, which is currently the country with the highest prevalence of DM in Southeast Asia. The most common type of DM currently is type 2 DM, the majority of which is caused by an unhealthy lifestyle, causing insulin resistance. Apart from causing diabetes, insulin resistance also causes dyslipidemia and is one of the most important factors in the occurrence of atherosclerosis which has an impact on the emergence of diabetic ulcers. This study aimed to determine the lipid profile in patients with type 2 diabetes mellitus. The research design used was descriptive with an observational approach. The variable observed in this study was the lipid profile in type 2 DM patients. The sampling technique used was simple random sampling with a sample size of 47 people. The instrument used is a documentation sheet. The research was conducted at the Klungkung Regional General Hospital (RSUD). The data collected was analyzed using descriptive statistics, and the data was then presented in a table. The results of the study showed that the total cholesterol value in type 2 diabetes mellitus sufferers with total cholesterol values above 200 mg/dL was 26,4%, and the LDL value in type 2 diabetes mellitus sufferers with values above 100 mg/dL was 26,3%. The HDL value in type 2 diabetes mellitus sufferers with a value of less than 40 is 13,0%, and the triglyceride value in type 2 diabetes mellitus sufferers with a value of more than 150 mg/dL is 26,1%. Most respondents have a good lipid profile, but there are still respondents whose lipid profile is not within the normal range and are at risk of developing diabetic ulcers.

Antibacterial and antibiofilm activities of zingerone and niosomal zingerone against methicillin-resistant Staphylococcus aureus (MRSA).

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial and community acquired infections. Nanoparticles are considered as proper tools to overcome the therapeutic problem of antimicrobial-resistant infections because of the drug concentration increment at the desired location and protection from enzymatic degradation. The goal of this study was to evaluate the effect of the antibacterial and antibiofilm activities of zingerone and niosome containing zingerone against pre-formed biofilm of MRSA isolates. 62 MRSA isolates cultured from patients with diabetic ulcers were investigated. Niosomes were synthesized and characterized by X-ray diffraction, zeta potential and scanning electron microscopy (SEM). The size of niosomal particles measured by SEM and zetasizer. The surface charge of prepared niosomes was about -37 mV. The effect of the zingerone and noisome containing zingerone was evaluated against biofilms of MRSA isolates. Also, the antibiofilm activity of prepared niosomes on gene expression of MRSA biofilms was evaluated using Real Time PCR. Our results demonstrated that the niosome containing zingerone had a diameter of 196.1 nm and a -37.3-mV zeta potential. Zingerone removed one and three-day old biofilms of MRSA at the concentration of 1000 μg/ml, while the zingerone-laoded niosomes removed 1, 3- and 5-days old biofilms at the concentration of 250 μg/ml, 250 μg/ml, and 500 μg/ml. The results indicated that niosome containing zingerone eliminated MRSA and its biofilms faster compared with free zingerone and it suggested that zingerone-encapsulated niosomes could be considered as a promising treatment against MRSA and its biofilms.

The Effect of Gel Secretome Hypoxia Mesenchymal Stem Cells to Increase P38 and VEGF Expression in Rats’ Diabetic Wounds

Mesenchymal stem cells (MSCs) under hypoxic conditions can produce secretomes containing growth factors such as vascular endothelial growth factor (VEGF), accelerating angiogenesis in wound healing disorders in diabetic ulcers. This study aimed to prove the influence of gel secretome MSC hypoxia administration on increasing VEGF and P38 gene expression in rats’ diabetic wounds. An in vivo study was conducted on 25 male Rattus norvegicus, randomly divided into four groups: base gel as a negative control, Gentamycin as a positive control, and gel secretome at a dose of 100 µL, and 200 µL/kg body weight. The differences in P38 and VEGF gene expression were tested using quantitative real-time polymerase chain reaction (qRT-PCR). Wound closure appeared to be fastest in treatment groups at a dose of 100 µL/kg body weight, followed by a dose of 200 µL/kg body weight, followed by Gentamycin and base gel group. The wound closure rate percentage was significantly different in the intervention group compared to the control group (p = 0.000). The results showed a significant difference in P38 and VEGF gene expression between the treatment and control groups (p = 0.000). This study demonstrates the administration of gel secretome hypoxia mesenchymal stem cells increases P38 and VEGF expression in rats’ diabetic wounds.

Enhanced Protease Production from Diabetic Ulcer-Derived E. coli

This study explored a local Escherichia coli isolate from diabetic foot ulcer patients for protease enzyme production. Qualitative screening on skim milk agar showed a 6 mm hydrolysis halo, while quantitative screening with casein revealed a specific activity of 144.55 U/mg protein. Purification via ion exchange chromatography on DEAE-cellulose increased the specific activity to 767.5 U/mg, with a 5.3-fold enhancement and a 29.5% yield. The findings suggest E. coli as a viable source for protease production and demonstrate the efficiency of ion-exchange chromatography for enzyme purification, with potential significant industrial applications. Highlight: E. coli sourced from diabetic ulcers shows promise for protease production. Skim milk agar and casein used for qualitative and quantitative screening. Ion exchange chromatography significantly enhances enzyme specific activity. Keywoard: Escherichia coli, protease production, diabetic foot ulcer, enzyme purification, ion exchange chromatography

SINGLE-STAGE, COMBINED, ORTHO-PLASTICS TREATMENT OF SEVERE CALCANEAL OSTEOMYELITIS WITH LARGE SOFT-TISSUE DEFECTS: LONG-TERM FOLLOW-UP

BackgroundCalcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below knee amputation; particularly in cases of severe soft tissue destruction.AimAssess the outcomes of combined ortho-plastics treatment of complex calcaneal osteomyelitis.MethodA retrospective review was performed of all patients who underwent combined single stage ortho-plastics treatment of calcaneal osteomyelitis (2008–2022). Primary outcome measures were osteomyelitis recurrence and BKA. Secondary outcome measures included flap failure, operative time, complications, length of stay.Results33 patients (16 female, 17 male, mean age = 54.4 years) underwent combined ortho-plastics surgical treatment for BACH “complex” calcaneal osteomyelitis with a median follow-up of 31 months (s.d. 24.3). 20 received a local flap, 13 received a free flap. Fracture-related infection (39%) and diabetic ulceration (33%) were the commonest causes. 54% of patients had already undergone at least one operation elsewhere. There were seven cases of recurrent osteomyelitis (21%); all in the local flap group. One patient required a BKA (3%). Recurrence was associated with increased mortality risk (OR 18.8 (95% CI 1.5–227.8), p=0.004) and reduced likelihood of walking independently (OR 0.14 (95% CI 0.02–0.86), p=0.042).Local flap reconstruction (OR 15 (95% CI 0.8–289.6), p=0.027) and peripheral vascular disease (OR 39.7 (95% CI 1.7–905.6), p=0.006) were associated with increased recurrence risk.Free flap reconstruction took significantly longer intra-operatively than local flaps (443 vs 174 minutes, p<0.001), but without significant differences in length of stay or frequency of out-patient appointments.ConclusionsSingle stage ortho-plastic management was associated with 79% eradication of infection and 3% amputation in this complex and co-morbid patient group. Risk factors for failure were peripheral vascular disease and local flap reconstruction. Whilst good outcomes can be achieved, this treatment requires high levels of in-patient and out-patient care.

Pemberdayaan Kader Melalui Program “SI KEPO DM” Sebagai Upaya Pencegahan Diabetic Foot Ulcer dengan Pendekatan Paliatif

Diabetes mellitus (DM) is a group of chronic metabolic diseases characterized by increased blood glucose levels, which over time can cause serious complications if not treated properly (WHO, 2018). SI KEPO DM (Screening, Recognizing and Caring for Diabetes Mellitus) program is used to prevent and early detect Diabetes Mellitus and the emergence of DM Ulcers. Screening to prevent the emergence of DM ulcers with SMART, namely regular health checks, get rid of cigarette smoke, exercise and physical activity regularly, have a balanced diet, get enough rest and manage stress well. Nowadays, many people do not provide enough fiber in their food, they consume a lot of food that contains cholesterol, saturated fat and sodium, which is made worse by the frequent consumption of foods and drinks that are rich in sugar. Based on a preliminary study, it was found that there was one resident of Karagayu sub-district with a diabetic ulcer who died due to a lack of knowledge regarding the prevention and treatment of Diabetic Ulcer wounds and chose to seek alternative treatment. There is a lack of knowledge regarding screening for early detection of DM as well as how to recognize and care for diabetes mellitus to prevent the appearance of ulcers, so it is necessary to actualize elderly cadres to carry out the Screening, Recognize and Care for Diabetes Mellitus Program as an effort to prevent the appearance of DM Ulcers in the elderly or those who abbreviated as the “SI KEPO DM” program.

Sirtuin-6 knockout causes exacerbated stalled healing of diabetic ulcers in mice

BackgroundDiabetic ulcers (DUs) are characterized by chronic inflammation and delayed re-epithelialization, with a high incidence and weighty economic burden. The primary therapeutic strategies for refractory wounds include surgery, non-invasive wound therapy, and drugs, while the optimum regimen remains controversial. Sirtuin-6 (SIRT6) is a histone deacetylase and a key epigenetic factor that exerts anti-inflammatory and pro-proliferatory effects in wound healing. However, the exact function of SIRT6 in DUs remains unclear. MethodsWe generated tamoxifen-inducible SIRT6 knockout mice by crossing SIRT6flox/flox homozygous mice with UBC-creERT2+ transgenic mice. Systemic SIRT6 null mice, under either normal or diabetic conditions, were utilized to assess the effects of SIRT6 in DUs treatment. Gene and protein expressions of SIRT6 and inflammatory cytokines were measured by Western blotting and RT-qPCR. Histopathological examination confirmed the altered re-epithelialization (PCNA), inflammation (NF-κB p50 and F4/80), and angiogenesis (CD31) markers during DUs restoration. ResultsKnockout of SIRT6 inhibited the healing ability of DUs, presenting attenuated re-epithelialization (PCNA), exacerbated inflammation responses (NF-κB p50, F4/80, Il-1β, Tnf-α, Il-6, Il-10, and Il-4), and hyperplasia vascular (CD31) compared with control mice. ConclusionsSIRT6 could boost impaired wound healing through improving epidermal proliferation, inflammation, and angiogenesis. Our study highlighted the therapeutic potential of the SIRT6 agonist for DUs treatment.

EFECTIVENESS OF USING A COMBINATION OF HYDROGEL AND HYDROCELLULAR FOAM IN THE PROCESS OF AUTOLYTIC DEBRIDEMENT IN HEALING DIABETIC ULCERS

Diabetic ulcers are a chronic complications of diabetes mellitus, which can increase the prevalence of morbidity and mortality in diabetes mellitus sufferers. To prevent this incident, diabetic ulcers, which are chronic wounds, need to be given proper and correct wound care. This research aims to determine the effectiveness of using a combination of hydrogel and hydrocellular foam in the autolytic debridement process for healing diabetic ulcers. This case report involves two respondents suffering from diabetes mellitus complicated by diabetic ulcers. This wound care intervention was carried out by a certified expert nurse eight times within a period of 14 days. Then, in assessing the progress of wound healing in the two respondents, the researcher used the Wocare for Indonesian Nurses (WINNERS) Scale observation sheet. The results of the study showed that the condition of the diabetic ulcers in both respondents experienced healing, which was characterized by increased growth of granulation tissue and epithelialization at the edges of the wound; the diameter and depth of the wound decreased; the GOA in the wound decreased; the characteristics of the exudate changed; and the amount of exudate decreased. The use of a combination of hydrogel and hydrocellular foam, which has proven to be effective in assisting the autolytic debridement process and increasing the speed of wound healing, can be carried out on various types and severity of wounds without causing any side effects.

Effects of Recombinant Human Granulocyte/Macrophage Colony-Stimulating Factor on Diabetic Lower Extremity Ulcers: Case Series of Nine Patients [Response to Letter

Effects of Recombinant Human Granulocyte/Macrophage Colony-Stimulating Factor on Diabetic Lower Extremity Ulcers: Case Series of Nine Patients [Response to Letter

Healing of diabetic ulcers using jamaican cherry leaf extract cream (Muntingia calabura l.) based on collagen density in white rats (Rattus norvegicus)

Abstract This research aims to determine the potential of jamaican cherry leaf extract cream (JCLEC) to accelerate the healing process of diabetic ulcers in white rat based on collagen density. The research used 4 month old male white rats (Rattus norvegicus) which were divided into K0 (negative control), KP (silver sulfadiazine), K1 (5% JCLEC), K2 (10% JCLEC), and K3 (15% JCLEC). An incision was made on the back of the rat then given JCLEC. Days 3, 7, and 14 after treatment, the wound tissue was collected after the rat were euthanized. Skin tissue was processed and stained with picrosirious red. The rate of wound healing was observed. Collagen density was presented in scoring. Based on the treatment group and observation time, there was a significant difference in collagen density between the treatment groups compared to the control (P<0.05). Based on the treatment group, the scoring of the collagen density was 1.78±0.6 (K0); 2.56±0.88 (KP); 1.78±0.4 (K1); 2.56±0.88 (K2); and 3.1±0.78 (K3). Based on observation time, the average collagen density scoring was 1.8±0.3 (D-3); 2.6±0.4 (D-7); and 2.8±0.6 (D-14). The conclusion is the 15% JCLEC has the potential to accelerate the healing of diabetic ulcers in white rats by stimulate collagen density.

Spatiotemporally responsive cascade bilayer microneedles integrating local glucose depletion and sustained nitric oxide release for accelerated diabetic wound healing

High glucose level, bacterial infection, and persistent inflammation within the microenvironment are key factors contributing to the delay of diabetic ulcers healing, while traditional therapeutic methods generally fail to address these issues simultaneously. Here, we present a spatiotemporally responsive cascade bilayer microneedle (MN) patch for accelerating diabetic wound healing via local glucose depletion and sustained nitric oxide (NO) release for long-term antibacterial and anti-inflammatory effects. The MN patch (G/AZ-MNs) possesses a degradable tip layer loading glucose oxidase (GOx), as well as a dissolvable base layer encapsulating l-arginine (Arg)-loaded nanoparticles (NPs). After wound administration, the base part rapidly dissolved, resulting in prompt separation of the MN tip within the wound tissue, which subsequently responded to the overexpressed matrix metalloproteinase-9 (MMP-9) in diabetic lesions, leading to the responsive release of GOx. The released enzyme catalyzed glucose into gluconic acid and hydrogen peroxide (H2O2), which not only reduced glucose level within the diabetic wound, but also initiated the cascade reaction between H2O2 with the Arg that was released from NPs, thereby achieving continuous production of NO for 7 days. Our findings demonstrate that a single administration of the MN patch could effectively heal non-infected or biofilm-infected diabetic wounds with the multifunctional properties.

Topical application of a hyaluronic acid-based hydrogel integrated with secretome of human mesenchymal stromal cells for diabetic ulcer repair

This preclinical proof-of-concept study aimed to evaluate the effectiveness of secretome therapy in diabetic mice with pressure ulcers. We utilized a custom-made hyaluronic acid (HA)-based porous sponge, which was rehydrated either with normal culture medium or secretome derived from human mesenchymal stromal cells (MSCs) to achieve a hydrogel consistency. Following application onto skin ulcers, both the hydrogel-only and the hydrogel + secretome combination accelerated wound closure compared to the vehicle group. Notably, the presence of secretome significantly enhanced the healing effect of the hydrogel, as evidenced by a thicker epidermis and increased revascularization of the healed area compared to the vehicle group. Notably, molecular analysis of healed skin revealed significant downregulation of genes involved in delayed wound healing and abnormal inflammatory response in ulcers treated with the hydrogel + secretome combination, compared to those treated with the hydrogel only. Additionally, we found no significant differences in therapeutic outcomes when comparing the use of secretome from fetal dermal MSCs to that from umbilical cord MSCs. This observation is supported by the proteomic profile of the two secretomes, which suggests a shared molecular signature responsible of the observed therapeutic effects.

Effect of pomegranate peel with/without autologous bone marrow on healing of acute cutaneous wounds in alloxan-induced diabetic rabbits.

Healing of bum wounds is commonly associated with many complications. Every year various new repair materials are developed and experimentally used for treating burn wounds. Humans with diabetes mellitus usually suffer from chronic wound healing. Vascular, neuropathic, immune function, and biochemical abnormalities each contribute to the altered tissue repair. One underlying factor that accompanies all diabetic ulcerations is poor vascular flow, a circumstance that impedes proper wound healing. Numerous studies have highlighted the importance of adequate vascular sufficiency and vessel proliferation in tissue repair and the lack thereof in diabetic wound healing. Other studies have looked at whether disarrayed capillary remodeling and maturation of vessels might play a role in impaired diabetic wound healing. This investigation has been planned to report the influence of treatment with a mixture of both the powder of pomegranate peel (PP) accompanied with an autologous bone marrow (BM) on the cure of burn injuries in experimentally induced diabetic rabbits. Alloxan monohydrate has been applied to create diabetes in 50 rabbits. Then in each rabbit, two deep second-degree burn wounds were experimentally created. The animals were then divided randomly into 5 treatment sections: non-treatment controls (C1), treated with an available commercial powder for wound (C2), treatment with powder of PP, treatment with alone BM, and the final group treated with PP powder with bone marrow (PPBM). The speed of wound closure and the histopathological changes during healing were measured. The levels of the biomarkers of rabbit platelet-derived growth factor AA (PDGF-AA) and rabbit protease-activated receptor 1 (PAR-1) were measured on days 0, 4, 8, and 12. Wound healing was markedly more rapid in all the treatment groups versus the control non-treated group. Interestingly, a rapid wound cure was significantly observed in the PPBM group versus the other treatment ones. The histological assessment clarified a significant elevation in the fibroblast and collagen scores in the PPBM group versus the other sections. In addition, there were significant increases in the serum levels of the biomarkers PDGF-AA and PAR-1 among groups. Dependent on the results of current research, it can be concluded that both PP powder with BM PPBM significantly accelerate the healing process of burn wounds in experimentally induced diabetic rabbits.

A STUDY OF PREVALENCE, CLINICAL PRESENTATION AND MANAGEMENT OF LOWER LIMB ULCERS AT A TERTIARY HOSPITAL

Background: Lower limb ulcers are debilitating and painful, greatly reducing patients quality of life. These ulcers are often difficult to treat. The most common aetiologies for lower limb ulcers are venous, arterial, mixed venous and arterial, diabetic and pressure ulcers. However, atypical wounds comprise approximately 20% of chronic wounds and should be kept in mind during differential diagnosis.The successful ulcer management depends upon the accurate diagnosis and treatment of the underlying cause, and it often needs a multidisciplinary approach. Methods: This prospective cross-sectional study conductedin Department of General Surgery atBasaveshwara Teaching and General Hospital, Attached to Mahadevappa Rampure Medical College, Kalaburagi. The study was conducted during the period from June 2022 to December 2023 which included 97 patients presenting withlower limb ulcers and admitted in surgical wards of our hospital. Results: Most of the patients were engaged in agriculture (24%) followed by business (23%) and service (14%). 47.5% of the patients had habit of smoking,alcohol consumption and tobacco chewing. Most of the ulcers were diabetic (36.1%) followed by venous (22.6%) (Z=2.17 p=0). Only 4.1% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (26.8%) was the most common cause of ulcer followed by venous hypertension (24.7%).In most of the cases, debridement with dressing (32.9%) and Debreidment+dressing+skin grafting (19.6%) was done. At the end of study period, 90 ulcers were healed, 4 were disease free, 2 had recurrence and 1 patient died. Conclusion:A comprehensive assessment of patients general status, personal habits, skin, vascular status, limb, ulcer characteristics are required to determine the etiology and to formulate effective treatment plan. Thus, the study of various cases of lower limb ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of lower limb ulcers. Education and training are vital for all those involved in caring of patients with ulcer.

Co electrospinning -poly (vinyl alcohol)-chitosan/gelatin-poly (ϵ-caprolacton) nanofibers for diabetic wound-healing application

With the increasing prevalence of diabetes, the healing of diabetic wounds has become a significant challenge for both healthcare professionals and patients. Recognizing the urgent need for effective solutions, it is crucial to develop suitable scaffolds specifically tailored for diabetic wound healing. In line with this objective, we have developed novel hybrid nanofibrous scaffolds by combining polyvinyl alcohol/chitosan (PVA/CS) and gelatin/poly(ε-caprolactone) (Gel/PCL) polymers through a double-nozzle electrospinning technique. In this study, we investigated the influence of the Gel/PCL blend ratio on the properties of the resulting nanofibers. Three different hybrid scaffold structures were examined: Gel/PCL (80:20)-PVA/CS (80:20), Gel/PCL (50:50)-PVA/CS (80:20), and Gel/PVA (20:80)-PVA/CS (80:20). Our findings demonstrate that the electrospun nanofibers of PVA/CS (80:20)-Gel/PCL (80:20) exhibited optimal mechanical performance, with a contact angle of approximately 54° and a diameter of 183 nm. Considering the crucial role of inhibiting bacterial adhesion in the success of implanted materials, we evaluated the cytocompatibility of the hybrid electrospun nanofibers using mouse fibroblast cells (L-929 cells). The in vitro cytotoxicity results obtained from L-929 fibroblast cell culture on the hybrid scaffolds revealed enhanced cell proliferation and appropriate cell morphology on the PVA/CS (80:20)-Gel/PCL (80:20) sample, indicating its capability to support tissue cell integration. Based on the information obtained from this study, the fabricated hybrid scaffold holds great promise for diabetic ulcer healing. Its optimal mechanical properties, suitable contact angle, and favorable cytocompatibility highlight its potential as a valuable tool in the field of diabetic wound healing. The development of such hybrid scaffolds represents a significant step forward in addressing the challenges associated with diabetic wound care.

Dose-response and efficacy of 904nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial.

This study aimed to examine the impact of a 904nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904nm 30w) with three different energy densities (4J/cm2; 8J/cm2; 10J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. GaAs 904nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). GaAs 904nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. NCT04246814.