Diabetic Wound Care Research Articles

Flexible electrical stimulation device with Chitosan-Vaseline® dressing accelerates wound healing in diabetes

The healing process of diabetic wounds is typically disordered and prolonged and requires both angiogenesis and epithelialization. Disruptions of the endogenous electric fields (EFs) may lead to disordered cell migration. Electrical stimulation (ES) that mimics endogenous EFs is a promising method in treating diabetic wounds; however, a microenvironment that facilitates cell migration and a convenient means that can be used to apply ES are also required. Chitosan-Vaseline® gauze (CVG) has been identified to facilitate wound healing; it also promotes moisture retention and immune regulation and has antibacterial activity. For this study, we created a wound dressing using CVG together with a flexible ES device and further evaluated its potential as a treatment for diabetic wounds. We found that high voltage monophasic pulsed current (HVMPC) promoted healing of diabetic wounds in vivo. In studies carried out in vitro, we found that HVMPC promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs) by activating PI3K/Akt and ERK1/2 signaling. Overall, we determined that the flexible ES-chitosan dressing may promoted healing of diabetic wounds by accelerating angiogenesis, enhancing epithelialization, and inhibiting scar formation. These findings provide support for the ongoing development of this multidisciplinary product for the care and treatment of diabetic wounds.

Intralesional allogeneic adipose-derived stem cells application in chronic diabetic foot ulcer: Phase I/2 safety study

BackgroundImpaired wound healing is a major cause of morbidity in diabetic patients by causing chronic ulcers. This study aimed to investigate the safety and outcomes after intralesional allogeneic adipose-derived mesenchymal stem cells injection in chronic diabetic foot ulcers. MethodsTwenty patients (12 male and eight female) were involved in the study. We randomized the patients into two groups of 10 patients each. The study group was treated with allogeneic adipose-derived mesenchymal stem cells injection with standard diabetic wound care. The control group received only standard diabetic wound care. Patient demographics, wound characteristics, wound closure time, amputation rates and clinical scores were evaluated. ResultsThe mean age was 57.3 ± 6.6 years. The mean follow-up duration was 48.0 (range, 26–50) months. Wound closure was achieved in 17 of 20 lesions (study group, 9 lesions; control group, 8 lesions; respectively). The mean time to wound closure was 31.0 ± 10.7 (range, 22–55) days in the study group, 54.8 + 15.0 (range, 30–78) days in the control group (p = 0.002). In three patients, minor amputations were performed (one patient in study group; two patients in the control group, p = 0.531). There was a significant difference between groups in terms of postoperative Short Form 36- physical functioning (p = 0.017) and Short Form 36-general health (p = 0.010). ConclusionAllogeneic adipose-derived mesenchymal stem cells injection was found to be a safe and effective method with a positive contribution to wound-healing time in the treatment of chronic diabetic foot ulcers.

Non-invasive monitoring of pharmacodynamics during the skin wound healing process using multimodal optical microscopy

ObjectiveImpaired diabetic wound healing is one of the serious complications associated with diabetes. In patients with diabetes, this impairment is characterized by several physiological abnormalities such as metabolic changes, reduced...

Measurement of peripheral arterial tonometry in patients with diabetic foot ulcers during courses of hyperbaric oxygen treatment.

Treatment of diabetic foot ulcers is complex and often protracted. Hyperbaric oxygen treatment (HBOT) improves wound healing in diabetic ulcers and serves as an important adjunct to regular diabetic wound care. Endothelial dysfunction plays a central role in diabetes-related vascular complications and may be evaluated by a non-invasive technique called peripheral arterial tonometry which measures a reactive hyperaemia index (RHI). We hypothesized that endothelial function measured by peripheral arterial tonometry is impaired in diabetic foot ulcer patients and that HBOT might improve endothelial function. Endothelial function was prospectively assessed by peripheral arterial tonometry in 22 subjects with diabetic foot ulcers and 17 subjects without diabetes during courses of HBOT. Endothelial function was evaluated before first (baseline) and 30th treatments, and at 90-day follow-up. Serum insulin growth factor-I (IGF-I) concentrations were determined by immunoassay. Results were compared to 23 healthy subjects. No baseline differences were found in endothelial function between subjects with diabetes, HBOT patients without-diabetes and healthy control subjects (RHI; 1.26, 1.61 and 1.81, respectively). No significant changes in RHI were found in patients with (P = 0.17) or without (P = 0.30) diabetes during courses of HBOT. At 90-day follow-up IGF-I was significantly reduced in the subjects with diabetes (P = 0.001) and unchanged in the group without diabetes (P = 0.99). We found no significant differences in RHI between subjects with diabetic foot ulcers and patients without diabetes, nor improvement in endothelial function assessed by peripheral arterial tonometry during courses of HBOT.

To evaluate transmetatarsal amputation in diabetic foot through the Amit Jain's system of practice - An experience from 2 different centre's

The aim of this study was to evaluate trans metatarsal amputation (TMA) done in diabetic foot through Amit Jain’s universal classification and scoring system and assess major amputations done in them. We conducted a descriptive retrospective analysis from 2 center’s namely Amit Jain’s Institute of Diabetic Foot &Wound Care at Brindhavvan Areion Hospital and at Department of surgery, Raja Rajeswari medical college, Bengaluru, India. The study period was from January 2017 to June 2018. 15 patients were recruited in the study with 73.3% of them being males. Around 20 % of them were above 70 years of age. Majority of patients who underwent TMA had open stump and it had significant association with duration of diabetes. Specialist diabetic foot surgeon had significant propensity to close the stump after trans metatarsal amputation (P

A Novel Functionalization of Bioactive Antimicrobial Peptide onto the Nano-CeO2/Reduced Graphene Oxide Cluster Type Biocomposite Wound Dressings for Diabetic Wound Care Management: In Vitro and In Vivo Evaluations

Diabetic wound ulcers and unhealed ulcerations have caused in severe difficulties of diabetic patients all around the world. The anti-microbial peptides (AMP) and nanomaterials have been demonstrated beneficial in diabetic wound healing studies. Diabetic wound healing process can be delayed significantly due to the infection issues. Hence in this report, biologically synthesized cerium oxide (CeO2) nanoparticles incorporated with reduced graphene oxide (RGO) and AMP for effective and rapid diabetic wound healing have been reported. At first, reduced graphene oxide was prepared from graphene oxide to prepare CeO2/RGO nanocomposites. Biocompatible AMP (IP-1) functionalized CeO2/RGO nanocomposites were accordingly prepared to study the diabetic wound healing process. Rats, the wound healing models with the wound size of about 1.5 cm2 were tested with the as-prepared samples. Further, the prepared samples were tested in a wound healing model of rate with the wound of size 1.5 cm2. Almost complete recovery of wounds i.e., 100% closure of wound area was observed after 2 weeks of treatment by the prepared samples. Biocompatible AMP (IP-1) functionalized CeO2/RGO nanocomposites enhances rapid keratinocytes proliferation by short time thereby it proves the enhanced ability of the prepared samples to act as a wound healing in-vivo drugs. HE and MTC staining protocols to illustrate histological observations elucidates the keratinocytes creation by biocompatible AMP (IP-1) functionalized CeO2/RGO nanocomposites.

Knowledge, Attitude and Practice on Diabetic Wound Care Management among Healthcare Professionals and Impact from A Short Course Training in Sabah, Borneo.

ObjectiveHealthcare professionals with an advanced level of knowledge and skills on diabetic wound care management are needed to effectively manage complex wounds. This study aimed to determine the effects of an educational intervention to enhance the management of wound care among healthcare professionals.MethodThis study was part of a quasi-experimental pre-post research design where 82 healthcare professionals were recruited and assigned to intervention and control groups. The participants in the intervention group attended two days of educational intervention training on diabetic wound care management, while there was no intervention in the control group. A questionnaire on knowledge, attitude, and practice was applied before and one-month post-intervention to both groups.ResultsPre-test resulted in a low level of knowledge 72.1% and 74.4%, negative level of attitude 67.4% and 66.7%, and a moderate level of practice 79.1% and 76.9% in both intervention and control groups respectively. Post-test resulted in increasing levels of knowledge (76.7%), positive attitude (100%), and practice (76.7%) in the intervention group. At the same time, there was no significant change in the control group. Repeated Measure ANOVA for within-subject and between-subject effects resulted in a statistically significant p-value of 0.001 for knowledge, attitude, and practice after the educational intervention.ConclusionHealth professionals have only a moderate level of knowledge on diabetic wound care management. It is important to improve this level by specific trainings and by using a good training module.

Presence of pyrroloquinazoline alkaloid in Adhatoda vasica attenuates inflammatory response through the downregulation of pro-inflammatory mediators in LPS stimulated RAW 264.7 macrophages.

Introduction: Inflammation is the primary response caused due to harmful stimuli which are followed by the increased draining of plasma and immune cells from the body into the site of the injured tissue. A signaling cascade of growth factors and cytokines propagates and eventually matures in the inflammatory site involving the blood vessels and immune markers within the injured tissue in order to promote the renewal of the degenerated tissue. During a chronic disorder like diabetic foot ulcer, there is an obstinate inflammation which may act as a prime factor for limb amputation and upon persistent prevalence may even lead to death. Methods: This study focuses on the mode of action of ALK-F (alkaloid fraction) isolated from Adhatoda vasica in attenuating the nitric oxide production which was estimated by Griess assay, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) expression was analyzed by ELISA and expression of COX-2 and iNOS by RT-PCR and western blotting in LPS stimulated RAW 264.7 macrophages. Total intracellular ROS was analyzed by DCFH-DA probing and the presence of quinazoline alkaloid (vasicine) in the ALK-F was evidenced by high performance liquid chromatography (HPLC). Results: The ALK-F of A. vasica exhibited a significant inhibitory effect on LPS elicited nitrite production (13.2 ± 1.06 µM), iNOS, and COX-2 (2.6 and 3.3 fold) in a dose-dependent manner. There was a significant decrease in the generation of these pro-inflammatory cytokines TNF-α (1102 ± 1.02 pg/mL) and IL-6 (18 ± 0.87 ng/mL) and total intracellular ROS in the highest tested concentrations (1 µg and 10 µg) of ALK-F of A. vasica. HPLC analysis by the gradient elution method revealed the presence of 12% of quinazoline alkaloid vasicine in the crude alkaloid fraction. Conclusion: Thus this study communally suggests that attenuation of nitric oxide and the dysregulation of genes responsible for inflammation which deliberates A. vasica to conflict against inflammation and provide remedial benefits in diabetic wound care.

THE EFFECT OF INFRARED RAY AND COUNSELING ON DIABETIC FOOT ULCER HEALING PROCESS

Background: Diabetic foot ulcer is one of the chronic complications of diabetes mellitus caused by neuropathy, angiopathy and decreased endurance. The risk of amputation in patient with diabetes mellitus fifteen times greater compared to non-diabetic. Various efforts on diabetic foot wound care have been carried out but the results are still far from satisfactory. Until now, infrared and counseling effect on wound healing in diabetic foot cannot be explained.Objective: The purpose of this study was to examine the effect of infrared ray and counseling on diabetic foot ulcer healing process.Method: The research design was quasi-experimental design with posttest control group design, the population in this study were patients with grade 3 diabetic foot wounds, blood sugar 100-200 g/ dl, BMI 18.5 to 24.9, aged 35-55 years. Large sample in this study as many as 20 were divided into two groups, the control random sampling. The collection of data for the dependent variable using the observation sheet after the tenth day of treatment, which consists of the rate of growth of granulation, ankle brachial index and capillary refill time. Furthermore, the data were processed using non-parametric statistical significance level < 0.05.Result: The results showed that the infrared and counseling effect on the growth of granulation with a significance level (p = 0.0003), infrared and counseling influence ankle brachial index (p = 0.024), infrared and counseling effect on capillary and counseling effect on capillary refill time (p = 0.024).Conclusion: It can be concluded from this study that applying infrared and counseling has any impact on healing in diabetic foot ulcer, on the growth of granulation and improved blood in diabetic foot ulcers. Key words: Infrared Ray, Counseling, Foot Ulcer Healing.

Nanofiber-expanded human CD34+ cells heal cutaneous wounds in streptozotocin-induced diabetic mice

Despite advances in diabetic wound care, the significant number of amputations that occur every year demands more effective therapeutics. Herein, we offer an aminated polyethersulfone nanofiber-expanded human umbilical cord blood-derived CD34+ cells (henceforth CD34+ cells) effective therapy, tested in cutaneous wounds developed in streptozotocin-induced diabetic NOD/SCID mice. We show that systemic administration of CD34+ cells homed to the wound site and significantly accelerated wound closure. Wound closure was associated with improved re-epithelialization and increased neovascularization; and with decreased sustained pro-inflammatory activity of NF-κB and its downstream effector molecules TNF-α, IL-1β, and IL-6 at the wound bed. This finding was further supported by the observation of a decreased number of myeloperoxidase positive neutrophils, and concomitantly increased levels of IL-10. In addition, improved granulation tissue formation was observed along with higher collagen deposition and myofibroblasts and decreased expressions of MMP-1. Mechanistically, CD34+ cells reduced the level of MMP-1 expression by inhibiting recruitment of NF-κB to the MMP-1 promoter site in dermal fibroblasts. In summary, we provide evidence of a novel nanofiber-expanded CD34+ stem cell therapeutic development for treating diabetic wounds by defining their cellular and molecular mechanisms.

Kemudahan Penggunaan Alat Bantu Simple Foot Elevator (SFE) dalam Perawatan Luka Kaki Diabetes

Increasing the number of patients with DM, complications are also increasing, one of them is ulceration of the lower limbs, with or without infection and cause damage to the underlying tissue, hereinafter referred to as diabetic foot (KD) or diabetic foot wound. In the world, the number of diabetic foot patients is expected to continue to rise. Diabetic wound care also creates difficulties for the nurse. The purpose of this study is to analyze the level of ease of simple foot elevator (SFE) tools in the treatment of diabetic wounds. This type of research is quasi experimental Pre and Post Test Without Control Design by creating a prototype called SFE. This tool was then tested on 12 diabetic patient nurses with diabetic ulcer complications in the lower extremity area. The variable of this study is to measure the degree of ease of nurses in performing the treatment of Diabetic Injuries through the questionnaire. Data processing research with Mann Withney test with significance level (α = 0,05) or CI = 95%. The result of statistical test by using Mann-Whitney test is 0.014, the result p is less than α, meaning that statistically shows that the use of SFE (Simple Foot Elevator) tool is easy to be used by nurses when performing diabetic foot ulcer treatment in Room 3 Rumkital Dr. Ramelan Surabaya. The use of SFE is easy to use. So it can be recommended as one alternative tool that can be used in wound care.Keyword : Diabetes Mellitus, Diabetic Foot Wounds, SFE

Diabetes Foot Wound Healing—A Collaborative Approach

There exists limited data demonstrating that glycemic control can improve healing of diabetic foot wounds. From March through December 2017, patients followed in the Foot Wound Clinic of a large urban safety net health system were concurrently seen by diabetes specialists to determine whether improving glycemic control via an integrated treatment approach impacted wound healing. This pilot study is the first to examine the effect of diabetes specialty co-management with podiatric care of diabetic foot wounds. Sixty patients were included in the analysis of this pilot program and were followed for an average of 220 days. Patients were classified as having either improved glycemic control (IGC) or non-improved glycemic control (NIGC) defined as < 1% HbA1c change at study end. Cohort characteristics and outcomes are summarized in Table 1. All patients had aggressive diabetic foot care including wound debridement and appropriate antibiotic therapy as determined by their podiatrist. Ulcers worsened in 47% of NIGC patients compared to 13% of IGC patients with IGC patients having an average HbA1c reduction of 2%. With both NIGC and IGC groups receiving similar wound management, 63% of NIGC patients had decreased ulcer volume compared to 87% of IGC patients, suggesting that improving glycemic control, in collaboration with diabetes specialist co-management, contributes to improved wound healing and a trend for decreased resource utilization.Table 1. Cohort characteristics and study outcomesIGCNIGCp-valueTotal No. of patients3030Total No. of ulcers3641Median ulcer size (mm3)BaselineStudy End170010040Patients with improved ulcer healing, n (%)26 (87)19 (63)0.04HbA1c, mg/dLBaselineStudy End10.68.210.211.10.47<0.005Hypertension, n (%)Pre-existingControlled at baselineControlled at study end25 (83)19 (63)19 (63)24 (80)16 (53)21 (70)ED visitsTotal visitsAverage No. of visits per patientFoot relatedDiabetes related351.9104502.32620.190.020.38Average number of podiatric appointments570.92No. of patients seen by Diabetes specialistAverage No. of specialist visits per patientNo. of patients seen in co-management visitNo. seen in sporadic visitNo visits252.32505242.81686Lost to follow-up with diabetes specialist, n (%)13 (43)15 (50) Disclosure J.N. McNulty: None. B.J. Lewis: None. J. La Fontaine: None. A. Rose: None. M. Gomez: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. U. Gunasekaran: None. M.S. Ruiz: None.

Impaired cutaneous T-cell attracting chemokine elevation and adipose-derived stromal cell migration in a high-glucose environment cause poor diabetic wound healing

Diabetic wound care is a major health care concern. The major cause of non-healing of wounds in patients with diabetes mellitus (DM) patients mainly involves poor glycemic control, which hinders the migration of progenitor cells including mesenchymal stem cells to the wound site. In this study, we introduced adipose-derived stromal cells (ADSCs) into wound sites and demonstrated that the local transplantation of ADSCs accelerated DM-related wound healing. Furthermore, the migration ability of ADSCs, which diminishes in a high-glucose environment, was partially restored by the exogenous replenishment of the cutaneous T-cell attracting chemokine (CTACK/CCL27). Our findings suggest that CTACK is a potential novel therapeutic target in DM-related wound healing.

COMPARATIVE STUDY OF EFFECTIVENESS OF WOUND CLEANSING SOLUTION IN DIABETIC WOUND CARE

Introduction. Wound cleansing for diabetic wound care always used 0.9% of NaCl or other commercial solutions. Currently, the use of guavas leaves extract (Psidium guajava L) as an alternative wound cleansing solution has been started to be introduced as a part of complementary nursing. The aim of this study was to compare the effectiveness of commercially wound cleansing solution of 0.9% NaCl and guavas leaves extract in wound healing process of diabetes mellitus patients. Methods. This study used six respondents as a sample, by using quasi experiment methods of 4 times wound cleansing. In this experiment, the control group used NaCl 0.9% while a group of sample used guavas leaves extract as wound cleansing solutions. Result. The experimental result revealed that there was a significant result between types of wound cleansing solution effectiveness in NaCl 0.9% with an extract guavas leaves for some wound characteristics (Presentation of wound slough P value: 0.043; presentation of wound granulation Pvalue: 0.037 (α=0.05)). However, There were no significant result of effectiveness comparison between wound cleansing solution (NaCl 0.9% and Guavas Leaves Extract) for wound dimension and epithelial tissue characteristics (Wound wide Pvalue:0.184; wound long Pvalue: 0.361; epithelial tissue presentation Pvalue:0.072 (α=0.05). Discussion. These results confirmed that guava leaves extract can serve as an alternative wound cleansing solution as commercial wound cleansing solution such as 0.9% NaCl. Keywords: Guavas leaves extract, Diabetes mellitus, wound care, wound cleansing solution

Extraordinary Rapid Wound Healing Time in Diabetic patients treated with Microburst Insulin Infusion

Importance: Non-healing diabetic ulcerations of the foot lead to amputations and premature mortality. Microburst Insulin Infusion has demonstrated an ability to accelerate healing in otherwise non-healing wounds. Objective: To demonstrate the benefit of adding Microburst Insulin Infusion to conventional diabetic wound care to significantly decrease wound healing time. Methods: A case series of five patients received Microburst Insulin Infusion therapy for significant peripheral diabetic ulcerations after failing conventional wound care. These five cases were treated from 4 independent Microburst Insulin Infusion clinics. Four of the wounds exceeded 6 cm². Patient charts were reviewed and relevant data was collected. All individuals in this manuscript have given written informed consent to publish these case details. Setting: Multicenter referral clinics providing Microburst Insulin Infusion Therapy Exposure: Microburst Insulin Infusion is an adjunctive treatment to conventional diabetic therapy performed in an outpatient clinic setting. A weight based oral glucose dose is administered while pulsatile intravenous insulin is delivered by the Bionica Microdose pump. The treatment is comprised of three 1 hour sessions and occurs up to five times a week, when the patient presents with un-healing wounds. Main Outcomes and Measures: Time to wound healing. A secondary outcome was failure of wound healing. Hypothesis for this study was formulated post treatment. Results: A significant decrease in wound healing time was observed when utilizing Microburst Insulin Infusion. The mean time to complete healing was 84.2 days compared to 133 days in published literature(1). The patient with a foot wound measuring an amazing 228.6 cm² healed in 102 days and amputation was not necessary. There were no treatment failures in this small series. As a result of decreased healing time, there was an absence of infection and no amputations were required for these wounds. Conclusion and Relevance: The addition of Microburst Insulin Infusion therapy resulted in a shortening of the time to healing by 49 days (7 weeks) for patients with poor response to conventional wound care. This is a 37% reduction in the time to heal thus reducing risk of infection and additional healthcare costs. The mechanism of action of Microburst Insulin Infusion in healing diabetic wounds is still unclear, but may involve an improved cellular metabolism, decreased inflammation and increased levels of Nitric oxide that enhance peripheral vascular supply and tissue healing.

Jumlah Bakteri pada Luka Diabetik Kronik yang Dicuci Menggunakan Ekstrak Air Daun Jambu Biji (Psidium Guava)

<em>Various solutions have been recommended for cleanse the wound, however normal saline is favored. Aqueous guava leaf extracts have material that known for antibacterial in the diabetic wound care especially for cleansing. Guava leaf available in Indonesia, but there is unresolved debate about its use. This study use quasi-experimental with pre-test post-test design. Sample in this study consist 19 outpatients who had diabetic chronic wounds care in clinic Kitamura, Pontianak. Analysis of quantitative data was tested with non-parametric analysis, Wilcoxon test and Mann Whitney test to determine the effect of aqueous guava leaves extract in reducing bacterial. Results sowed that he number of bacteria colonies after cleansing the wound using aqueous guava leaves extract was decreased. P-value on first day until seventh day for 10% aqueous guava leaves was p=0.008 (p0.05), but 20% aqueous guava leaves extract most effective than 10% aqueous guava leaves extract.</em>

Nurses' knowledge on diabetic foot ulcer disease and their attitudes towards patients affected: A cross-sectional institution-based study.

To assess nurses' knowledge on diabetic ulcer disease and their attitudes towards patients suffering from it and to identify factors which influence them. Diabetic wound care is an evolving specialty with the rising prevalence of diabetes foot complications. As nurses play a key role in wound care, their knowledge and attitudes are important in providing optimum care to patients. Descriptive cross-sectional survey design. The study was conducted in three teaching hospitals. Data were collected using a pretested, validated, self-administered questionnaire from purposively recruited, voluntarily participating nurses (n=200) who were in diabetic wound care practice for ≥1year. Lack of formal wound care training was reported by 91.2%. Mean knowledge score was 77.9 (range 53.3-100 on a scale from 0-100) with 57.8% of nurses obtaining ≥80%. Nurses demonstrated an overall positive attitude towards caring for diabetic ulcer patients (median=41, range 23-50 on a scale from 10-50). However, the study identified deficits in core knowledge and some negative attitudes such as insensitivity to pain. Statistically significant associations were seen between nurses' knowledge and duration of nursing, wound care experience and the type of unit they are attached to. In-service education (77.2%) and knowledge sharing with peers (77.9%) were the most popular knowledge-updating sources. Although 98.6% of nurses were interested in wound care, only 8.3% wished to engage in research. No correlation was observed between nurses' knowledge and attitudes. Gaps in core knowledge and negative attitudes may be attributed to inadequate training, suboptimal update of knowledge and lack of interest in wound care research. Wound care training should be made mandatory to improve quality of care given by nurses to patients with diabetic ulcers. Continuous professional development, evidence-based practices and wound care research should be encouraged.

Synthesis, Characterization, and Antibacterial Activities of High-Valence Silver Propamidine Nanoparticles

Diabetic foot ulcer (DFU) is becoming more serious concern as it affects 95% of diabetic patients worldwide. It has been shown that the Staphylococcus aureus and other Gram-negative microorganisms are the main reasons behind this disease. Though many antibiotics are presently used to treat the DFU, due to increased bacterial resistance, new alternative therapies are always welcome. To address this alarming issue, we have designed and synthesized the high-valence silver propamidine (Ag(II)PRO) complex as well as nanoparticles and characterized both by usual spectroscopic methods. The reverse microemulsion technique has been applied to synthesize Ag(II)PRO nanoparticles and its antibacterial activity has been compared with zero-valence silver nanoparticles (AgNPs) with similar size. The antibacterial efficacies of Ag(II)PRO nanoparticles and AgNPs were tested against Gram-negative and Gram -positive organisms responsible for DFU. The newly synthesized high-valence Ag(II)PRO nanoparticles showed higher antibacterial activity compared to silver-only nanoparticles (AgNPs). This study concludes that the high-valence Ag(II)PRO nanoparticles show better antibacterial activity than AgNPs and they may serve as the next generation therapeutic agent for the diabetic wound care.

KEJADIAN DERAJAT LUKA DIABETES TIDAK BERHUBUNGAN DENGAN NILAI RISIKO DIABETIC FOOT ULCER

The highest diabetic complication percentage is neuropathy (54%) causing diabetic foot ulcer (DFU). The study aimed to know the relationship between diabetic foot ulcer risk levels with diabetic ulcer severity levels. Scope of the study was diabetic wound care, particularly on legs mostly experienced by diabetic patients. The method used was descriptive correlation with cross sectional design. Sampling method was non probability with purposive sampling. Respondent number was 16 persons with inclusion criteria was diabetic patients with ulcer in one leg and no ulcer on another side in the second visitation to a diabetic clinic in Bekasi,Indonesia and agreed to be involved in the study. DFU risk level instrument modified from Diabetes Foot Screening and Risk Stratification Form of New Zealand Society for Study of Diabetes (NZSSD) to measure the DFU degree on legs with no ulcer. Another tool was to measure severity level of legs with ulcer according to Wagner. Data analysis used Kendall’s tau with 0.05 of significance level. The result shows there is no relationship between DFU risk levels with severity degree of diabetic ulcers. From the study, we can conclude that nurses do not need provide specific DFU prevention based on diabetic ulcer severity grade.

Probing community nurses' professional basis: a situational case study in diabetic foot ulcer treatment.

Complicated and long-lasting wound care of diabetic foot ulcers are moving from specialists in wound care at hospitals towards community nurses without specialist diabetic foot ulcer wound care knowledge. The aim of the study is to elucidate community nurses' professional basis for treating diabetic foot ulcers. A situational case study design was adopted in an archetypical Danish community nursing setting. Experience is a crucial component in the community nurses' professional basis for treating diabetic foot ulcers. Peer-to-peer training is the prevailing way to learn about diabetic foot ulcer, however, this contributes to the risk of low evidence-based practice. Finally, a frequent behaviour among the community nurses is to consult colleagues before treating the diabetic foot ulcers.