Healing Of Diabetic Ulcers Research Articles

Bioactive triterpenoid compounds of Poria cocos (Schw.) Wolf in the treatment of diabetic ulcers via regulating the PI3K-AKT signaling pathway

Ethnopharmacological relevanceDiabetic ulcers represent a chronic condition characterized by prolonged hyperglycemia and delayed wound healing, accompanied by endocrine disorders, inflammatory responses, and microvascular damage in the epidermal tissue, demanding effective clinical treatment approaches. For thousands of years, ancient Chinese ethnopharmacological studies have documented the use of Poria cocos (Schw.) Wolf in treating diabetic ulcers. Recent research has substantiated the diverse pharmacological effects of Poria cocos (Schw.) Wolf, including its potential to alleviate hyperglycemia and exhibit anti-inflammatory, antioxidant, and immune regulatory properties, which could effectively mitigate diabetic ulcer symptoms. Furthermore, being a natural medicine, Poria cocos (Schw.) Wolf has demonstrated promising therapeutic effects and safety in the management of diabetic ulcers, holding significant clinical value. Despite its potential clinical efficacy and applications in diabetic ulcer treatment, the primary active components and underlying pharmacological mechanisms of Poria cocos (Schw.) Wolf remains unclear. Further investigations are imperative to establish a solid foundation for drug development in this domain. Aim of the study and Materials and methodsIn this study, we aimed to identify the active compounds and potential targets of Poria cocos (Schw.) Wolf using UHPLC-Q-TOF-MS and TCMSP databases. Additionally, we attempt to identify targets related to diabetic ulcers. Following enrichment analysis, a network of protein-protein interactions was constructed to identify hub genes based on the common elements between the two datasets. To gain insights into the binding activities of the hub genes and active ingredients, molecular docking analysis was employed. Furthermore, to further validate the therapeutic effect of Poria cocos (Schw.) Wolf, we exerted in vitro experiments using human umbilical vein vascular endothelial cells and human myeloid leukemia monocytes (THP-1). The active ingredient of Poria cocos (Schw.) Wolf was applied in these experiments. Our investigations included various assays, such as CCK-8, scratch test, immunofluorescence, western blotting, RT-PCR, and flow cytometry, to explore the potential of Poria cocos (Schw.) Wolf triterpenoid extract (PTE) in treating diabetic ulcers. ResultsThe findings here highlighted PTE as the primary active ingredient in Poria cocos (Schw.) Wolf. Utilizing network pharmacology, we identified 74 potential targets associated with diabetic ulcer treatment for Poria cocos (Schw.) Wolf, with five hub genes (JUN, MAPK1, STAT3, AKT1, and CTNNB1). Enrichment analysis revealed the involvement of multiple pathways in the therapeutic process, with the PI3K-AKT signaling pathway showing significant enrichment. Through molecular docking, we discovered that relevant targets within this pathway exhibited strong binding with the active components of Poria cocos (Schw.) Wolf. In vitro experiments unveiled that PTE (10 mg/L) facilitated the migration of human umbilical vein vascular endothelial cells (P < 0.05). PTE also increased the expression of CD31 and VEGF mRNA (P < 0.05) while activating the expressions of p-PI3K and p-AKT (P < 0.05). Moreover, PTE demonstrated its potential by reducing the expression of IL-1β, IL-6, TNF-α, and NF-κB mRNA in THP-1 (P < 0.05) and fostering M2 macrophage polarization. These results signify the potential therapeutic effects of PTE in treating diabetic ulcers, with its beneficial actions mediated through the PI3K-AKT signaling pathway. ConclusionsPTE is the main active ingredient in Poria cocos (Schw.) Wolf that exerts therapeutic effects. Through PI3K-AKT signaling pathway activation and inflammatory response reduction, PTE promotes angiogenesis, thereby healing diabetic ulcers.

Cascade-driven nanomotors promote diabetic wound healing by eradicating MRSA biofilm infection

Bacterial infection, hypoxia, and inflammatory stress responses are the key obstacles that delay the healing of diabetic ulcers. Herein, DMSNs-Pt-LOX@Nisin (DPLN) nanomotors that exhibits cascade propulsion and can specifically target methicillin-resistant Staphylococcus aureus (MRSA) is developed. The DPLN can facilitate the conversion of the abundant lactic acid existed in diabetic wounds, resulting in the generation of hydrogen peroxide (H2O2). Meanwhile, the unilateral Pt nanodendrites (Pt DNs) catalyze H2O2 to produce O2, driving the nanomotors to rapidly penetrate into the biofilm. Moreover, by loading Nisin, which can bind to lipid II of Gram-positive bacteria, the nanomotors can target MRSA through a self-driven process. Both in vitro and in vivo experiments demonstrate that the nanomotors can eradicate MRSA biofilms. Furthermore, animal studies show that DPLN are able to expedite the process of wound healing in diabetic mice through the eradication of biofilms, facilitation of angiogenesis, and mitigation of inflammation. These novel nanomotors combining cascade propulsion and MRSA targeting represent an encouraging and potentially effective approach in diabetic ulcer treatment.

Meta-Analysis: Effect of Hyperbaric Oxygen Therapy on Diabetic Foot Ulcer Recuperation

Background: Diabetes mellitus (DM) is a global phenomenon due to the high morbidity and mortality, especially in developing countries such as Indonesia. An ulcer is a wound and is usually found in patients who experience increased blood sugar and can cause peripheral blood vessel disorders, blood vessel disorders will result in peripheral neuropathy or a combination of both, diabetic ulcers are a condition often experienced by diabetes sufferers. Hyperbaric Oxygen Therapy (HBOT) is a therapy that is considered effective in healing diabetic ulcers and has been proven by many studies conducted. This study aims to analyze the effect of HBO therapy on the improvement of diabetic ulcer wounds. Subjects and Method: This was a systematic review and meta-analysis of primary studies. Article searches were carried out based on the PICO model. Population: diabetic ulcer patients. Intervention: Hyperbaric Oxygen Therapy. Comparison: placebo. Outcome: diabetic ulcers con­dition. Article searches were carried out from Google Scholar, MEDLINE/PubMed, Science Direct, Scopus, Hindawi, BMC, and Spinger Link databases. Keywords used "diabetic foot ulcers" AND "hyperbaric oxygen therapy". The inclusion criteria were full paper, RCT, and reporting risk ratio (RR). Selected studies were analyzed using the RevMan 5.3. Results: 9 RCTs from China, Canada, the Netherlands, Sweden, Egypt, Taiwan, England, and Turkey were selected for meta-analysis. HBO therapy increased diabetic ulcers condition (RR= 1.91; 95% CI= 1.17 to 3.12; p= 0.01). Conclusion: HBO therapy improves diabetic ulcers condition. Keywords: hyperbaric oxygen, diabetic foot ulcer, meta analisis.

Melatonin supplementation counteracts fiber loss in knee ligaments of diabetes-induced rats.

Diabetes mellitus (DM) is a prevalent metabolic disease. The clinical impact of sustained hyperglycemia on ligament healing has not been well characterized. Diabetes is a known cause of macro-, microvascular, and diabetic ulcer healing difficulties among tissues. Therefore, we aimed to investigate the healing potential occurring in injured and healthy ligaments among diabetic and healthy individuals using a rat model. We hypothesize that DM may contribute to altering the knee medial collateral ligament (MCL), thus its morphology, biochemical fitness, and functionality. The study cohort consisted of 40 rats. The animals were randomized into four equal groups. Groups I and II (20 rats) received saline subcutaneously and served as controls. Groups III and IV (20 rats) were injected with a single dose of streptozotocin (STZ). All animals underwent surgery to cut the left tibial collateral ligament in the hind limb and suture it. The access site was sutured to create inflammation and study the regenerative capacities of animals with normal carbohydrate metabolism and pharmacologically induced diabetes. Each animal then underwent sham surgery to access and suture the right tibial collateral ligament in the hind limb without ligament intervention. After the animals had undergone surgeries, groups II and IV were given melatonin supplementation for 4weeks. Rats with DM presented with more fibrosis and calcification of the MCL and decreased healing potential. Treatment with melatonin in diabetic rats mitigated alterations and improved the antioxidant status of ligaments from the diabetic group.

Plant-Derived Exosomes as Novel Nanotherapeutics Contrive Glycolysis Reprogramming-Mediated Angiogenesis for Diabetic Ulcer Healing.

Reversal of endothelial cell (EC) dysfunction under high-glucose (HG) conditions to achieve angiogenesis has remained a big challenge in diabetic ulcers. Herein, exosomes derived from medicinal plant ginseng (GExos) were shown as excellent nanotherapeutics with biomimetic cell membrane-like structures to be able to efficiently transfer the encapsulated active substances to ECs, resulting in a marked reprogramming of glycolysis by up-regulating anaerobic glycolysis and down-regulating oxidative stress, which further restore the proliferation, migration, and tubule formation abilities of ECs under HG conditions. Invivo, GExos enhance the angiogenesis and nascent vessel network reconstruction in full-thickness diabetic complicated skin ulcer wounds in mice with high biosafety. GExos were shown as promising nanotherapeutics in stimulating glycolysis reprogramming-mediated angiogenesis in diabetic ulcers, possessing wide application potential for reversing hyperglycemic dysangiogenesis and stimulating vascular regeneration.

Effectiveness of Sucralphate and Platelet-Rich Plasma Combinations For Vascular Endothelial Growth Factor (VEGF) Expression In Diabetic Ulcer Healing

Background: Diabetic ulcer is one of the most feared chronic infections due to Diabetes Mellitus because it can lead to amputation and death. Aim: To prove the effectiveness of sucralfate and platelet-rich plasma (PRP) combination for Vascular Endothelial Growth Factor (VEGF) expression in diabetic ulcer healing. Methods: This research is an experimental study of Phase I Clinical Trial with post-test only group design. There were 20 patients with diabetic ulcers divided into two groups, namely the treated group that was given sucralfate and PRP therapy and the control group was given standard therapy of normal saline drainage and gauze covered. Parameters were VEGF expression levels, wound area after being given therapy, and side effect from the treatment. Data on VEGF expression levels were obtained by means of examination with the Quantikine Human VEGF-ELISA Quantikine, R&amp;D System, Inc, Minneapolis. The measurement of the wound area was assessed based on several criteria, namely grade 0 (no change), grade 1 (wound size reduced to less than of the previous wound), grade 2 (wound size was reduced to less than of the previous wound, but granulation was visible), and grade 3 (wound has closed completely). Result: In unpaired t-test, the mean VEGF expression was 98.18+10.96 in the treatment group and 66.69+23.79 in the control group which showed significant difference in VEGF expression levels (p = 0.003). In Mann-Whitney test, the mean wound area was 0.68+0.40 in the treatment group and 0.77+0.67 in the control group which showed that there was not any significant difference in wound area (p = 0.152). There were no side effects in both study group. Conclusions: The combination of sucralfate and PRP can increase VEGF levels significantly in diabetic ulcer patients but does not show a different effect in reducing wound area compared to standard treatment. The combination did not cause any side effects in the study subjects, as well as those using standard treatment.

EFFECTIVENESS OF MODERN WOUND TREATMENT USING WANDING TECHNIQUES MOIST WOUND HEALING IN HEALING DIABETIC ULCERS IN CLINIC RUMAT JAKARTA

Diabetes Mellitus often becomes a serious health problem in various developing and developed countries in the world. Most people with diabetes mellitus are at risk of developing diabetic ulcers. If not treated quickly it can develop into an infection. The newest wound healing methods currently have an important role in treating diabetic ulcers, one of which is Modern Dressing with Moist Wound Healing. The aim of this research is to identify the effectiveness of modern wound care using moist wound healing dressing techniques in healing diabetic ulcers at the Rumat clinic in Jakarta. The research design used in this study used a quasi-experimental design with a cross-sectional method approach. The population in this study were all patients who underwent wound care at the Rumat Jakarta clinic. The sampling used was accidental sampling, which took cases or respondents who happened to be present or available in a place according to the research context, namely 30 respondents. Based on the results of the Paired T-Test and Independent T-Test, the p-value was obtained (0.000 &lt; α 0.05), this proves that there is the effectiveness of modern wound care using the Moist Wound Healing dressing technique in healing diabetic ulcers in home clinics in Jakarta. Meanwhile, in the control group, after carrying out bivariate analysis using statistical tests, a significance value of p value α = 0.080 (p &gt; 0.05) was obtained. Thus, it can be said that there is no effectiveness of modern wound care using moist wound healing dressing techniques in healing diabetic ulcers at the Rumat Clinic in Jakarta. It is hoped that the Jakarta Rumat Clinic can improve the quality and quality of modern wound care services using moist wound healing dressing techniques for diabetic ulcer sufferers.

Dynamic Microenvironment-Adaptable Hydrogel with Photothermal Performance and ROS Scavenging for Management of Diabetic Ulcer.

Persistent bacterial infections and excessive oxidative stress prevent the healing of diabetic ulcers, leading to an increased disability rate. Current treatments fail to kill bacteria while simultaneously relieving oxidative stress. Herein, a dynamic microenvironment-adaptable hydrogel (BP@CAu) with photothermal performance and reactive oxygen species scavenging is presented for diabetic ulcer healing. This hydrogel prepared using a dynamic borate-ester could respond to acidity in the infection microenvironment for a controllable drug release. An excellent photothermal conversion effect was integrated in the hydrogel, which exhibited strong antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa. The hydrogel attenuated intracellular oxidative stress and inflammation and promoted cell migration. In a full-thickness skin defect model of diabetic rats, the BP@CAu hydrogel contributed to the fastest wound closure, with ideal reepithelialization, granulation tissue formation, and regeneration of blood vessels. Further mechanistic studies revealed that the hydrogel relieved oxidative stress and downregulated the expression of inflammatory cytokines, resulting in dramatic therapeutic effects on diabetic wounds. Therefore, this study provides a synergistic therapeutic strategy for efficient photothermal performance and reactive oxygen species scavenging in diabetic ulcers.

Combination of Shengji ointment and bromelain in the treatment of exposed tendons in diabetic foot ulcers: study protocol for a non-blind, randomized, positive control clinical trial

BackgroundDiabetic foot ulcers often affect tendon tissue. Consequently, the infection may spread proximally along the tendon, leading to amputation or even the death of patients. Exposed, degenerated, and necrotic tendons are key factors affecting the healing of diabetic foot ulcers. The effective treatment of the tendon involvement may positively affect the prognosis. In clinical practice, treatment with Shengji ointment and bromelain induces islands of granulation tissue on the denatured tendon surface, which gradually grows and merges. Ideally, the exposed tendon is covered entirely by granulation tissue.This trial aims to assess the effect of a combined treatment regime of Shengji ointment, which has been shown to regenerate muscle tissue and pineapple protease in preventing the loss of function and amputation caused by tendon necrosis. This trial will provide high-quality evidence for the effectiveness of this combination in healing diabetic ulcers with tendon necrosis.MethodsThe sample size will be 180 patients who will be randomly assigned 1:1 to a treatment group (90 patients) using Shengji ointment combined with bromelain and a control group (90 patients) using hydrocolloid dressing. Both groups will continue their conventional treatments, such as blood glucose and blood pressure medication, lipid regulation, antiplatelets, and others. The primary outcome will be the wound coverage with granulation tissue. Secondary outcomes will be the wound healing rate, amputation extent (where needed), time to granulation, and the Maryland Foot Score. Other efficacy outcomes will be the time to debridement of necrotic tendon tissue and granulation tissue score.DiscussionThis study will treat patients with diabetic foot ulcers with exposed, degenerated, and necrotic tendons with Shengji ointment and bromelain. The trial aims to promote regeneration and healing, to preserve the limb and its function, and to develop a comprehensive and effective protocol that can be applied to promote the healing of exposed tendons in diabetic foot wounds.Trial registrationChiCTR2000039327; date of registration: 2020-10-23.

XB130 inhibits healing of diabetic skin ulcers through the PI3K/Akt signalling pathway.

Diabetic skin ulcers, a significant global healthcare burden, are mainly caused by the inhibition of cell proliferation and impaired angiogenesis. XB130 is an adaptor protein that regulates cell proliferation and migration. However, the role of XB130 in the development of diabetic skin ulcers remains unclear. To investigate whether XB130 can regulate the inhibition of proliferation and vascular damage induced by high glucose. Additionally, we aim to determine whether XB130 is involved in the healing process of diabetic skin ulcers, along with its molecular mechanisms. We conducted RNA-sequencing analysis to identify the key genes involved in diabetic skin ulcers. We investigated the effects of XB130 on wound healing using histological analyses. In addition, we used reverse transcription-quantitative polymerase chain reaction, Western blot, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining, immunofluorescence, wound healing, and tubule formation experiments to investigate their effects on cellular processes in human umbilical vein endothelial cells (HUVECs) stimulated with high glucose. Finally, we performed functional analysis to elucidate the molecular mechanisms underlying diabetic skin ulcers. RNA-sequencing analysis showed that the expression of XB130 was up-regulated in the tissues of diabetic skin ulcers. Knockdown of XB130 promoted the healing of skin wounds in mice, leading to an accelerated wound healing process and shortened wound healing time. At the cellular level, knockdown of XB130 alleviated high glucose-induced inhibition of cell proliferation and angiogenic impairment in HUVECs. Inhibition of the PI3K/Akt pathway removed the proliferative effects and endothelial protection mediated by XB130. The findings of this study indicated that the expression of XB130 is up-regulated in high glucose-stimulated diabetic skin ulcers and HUVECs. Knockdown of XB130 promotes cell proliferation and angiogenesis via the PI3K/Akt signalling pathway, which accelerates the healing of diabetic skin ulcers.

Paeonol accelerates skin wound healing by regulating macrophage polarization and inflammation in diabetic rats.

Diabetic ulcer is usually seen in people with uncontrolled blood sugar. Reportedly, many factors such as impaired glucose metabolism, and macrovascular and microvascular diseases caused angiogenesis disorders and delayed the healing of diabetic ulcers, thus affecting the body's metabolism, nutrition, and immune function. This study aimed to explore the effect of paeonol on skin wound healing in diabetic rats and the related mechanism. A rat model of diabetic ulcer was established. High glucose-treated mouse skin fibroblasts were co-cultured with M1 or M2-polarized macrophages treated with or without paeonol. H&E and Masson staining were used to reveal inflammatory cell infiltration and collagen deposition, respectively. Immunohistochemistry visualized the expression of Ki67, CD31, and vascular endothelial growth factor (VEGF). Western blot was used to detect interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-4, IL-10, CD31, VEGFA, and collagen I/III. The expression of iNOS and arginase 1 was revealed by immunofluorescence staining. Paeonol treatment augmented collagen deposition and the expression of Ki67, CD31, VEGF, and macrophage M2 polarization markers (IL-4 and IL-10) and reduced wound area, inflammatory cell infiltration, and macrophage M1 polarization markers (IL-1β and TNF-α) in the ulcerated area. In vitro, paeonol treatment promoted M2-polarization and repressed M1-polarization in macrophages, thereby improving the repair of cell damage induced by high glucose. Paeonol accelerates the healing of diabetic ulcers by promoting M2 macrophage polarization and inhibiting M1 macrophage polarization.

Microenvironment responsive nanocomposite hydrogel with NIR photothermal therapy, vascularization and anti-inflammation for diabetic infected wound healing.

Bacterial infection, excessive inflammation and damaging blood vessels network are the major factors to delay the healing of diabetic ulcer. At present, most of wound repair materials are passive and can't response to the wound microenvironment, resulting in a low utilization of bioactive substances and hence a poor therapeutic effect. Therefore, it's essential to design an intelligent wound dressing responsive to the wound microenvironment to achieve the release of drugs on-demand on the basis of multifunctionality. In this work, metformin-laden CuPDA NPs composite hydrogel (Met@ CuPDA NPs/HG) was fabricated by dynamic phenylborate bonding of gelatin modified by dopamine (Gel-DA), Cu-loaded polydopamine nanoparticles (CuPDA NPs) with hyaluronic acid modified by phenyl boronate acid (HA-PBA), which possessed good injectability, self-healing, adhesive and DPPH scavenging performance. The slow release of metformin was achieved by the interaction with CuPDA NPs, boric groups (B-N coordination) and the constraint of hydrogel network. Metformin had a pH and glucose responsive release behavior to treat different wound microenvironment intelligently. Moreover, CuPDA NPs endowed the hydrogel excellent photothermal responsiveness to kill bacteria of >95% within 10min and also the slow release of Cu2+ to protect wound from infection for a long time. Met@ CuPDA NPs/HG also recruited cells to a certain direction and promoted vascularization by releasing Cu2+. More importantly, Met@CuPDA NPs/HG effectively decreased the inflammation by eliminating ROS and inhibiting the activation of NF-κB pathway. Animal experiments demonstrated that Met@CuPDA NPs/HG significantly promoted wound healing of diabetic SD rats by killing bacteria, inhibiting inflammation, improving angiogenesis and accelerating the deposition of ECM and collagen. Therefore, Met@CuPDA NPs/HG had a great application potential for diabetic wound healing.

Therapy terhadap Penyembuhan pada Ulkus Diabetikum: Literature Riview

Diabetic ulcer is a disease that greatly affects the patient's quality of life, where the end of the course of the disease is that the patient must undergo an amputation. In Indonesia, diabetes shows an increasing incidence. Diabetic wounds that don't heal are a risk factor for infection and a major cause of amputations and death. One way of treatment is by treating wounds using the Negative Pressure Wound Therapy technique for healing diabetic ulcers. The research method used is a systematic review by identifying journal articles published online consisting of English in 2018-2021. Articles were retrieved using search engine tools PubMed, ScienceDirect, and JSTOR. There are 5 journals based on inclusion criteria. The results showed that there was an effect of wound care using the Negative Pressure Wound Therapy technique on the healing of diabetic ulcers.

Advanced dressings in the healing of diabetic ulcers

Advanced dressings in the healing of diabetic ulcers

A Sustained-Release Nanosystem with MRSA Biofilm-Dispersing and -Eradicating Abilities Accelerates Diabetic Ulcer Healing.

Drug-resistant bacterial infections and biofilm formation play important roles in the pathogenesis of diabetic refractory wounds. Tea tree oil (TTO) exhibits antimicrobial, antimycotic, and antiviral activities, especially against common clinically resistant strains, such as methicillin-resistant Staphylococcus aureus (MRSA), making it a potential natural antimicrobial for the treatment of acute and chronic wounds. However, TTO is insoluble in water, volatile, light-sensitive, and cytotoxic. While previous macroscopic studies have focused on sterilization with TTO, none have sought to alter its structure or combine it with other materials to achieve sustained release. Electrospun TTO nanoliposomes (TTO-NLs), arranged linearly via high-pressure homogenization, could stabilize the structure and performance of TTO to achieve slow drug release. Herein, we established a composite nano-sustained release system, TTO-NL/polyvinyl alcohol/chitosan (TTO-NL@PCS), using high-voltage electrospinning. Compared with the control, TTO-NL@PCS exhibits higher concentrations of the active TTO drug components, terpinen-4-ol and 1,8-cineole. Owing to its increased stability and slow release, early exposure to TTO-NL@PCS increases the abundance of reactive oxygen species in vitro, ultimately causing the biofilm to disperse and completely killing MRSA without inducing cytotoxic effects to the host. Moreover, in BKS-Leprem2Cd479/Gpt mice with a whole-layer skin infection, untargeted metabolomics analysis of wound exudates reveals upregulated PGF2α/FP receptor signaling and interleukin (IL)-1β and IL-6 expression following application of the composite system. The composite also ameliorates the chemotaxis disorder in early treatment and attenuates the wound inflammatory response during the repair stage of diabetic inflammatory wounds, and upregulates VEGF expression in the wound bed. TTO-NL@PCS demonstrates the remarkable potential for accelerating diabetic and MRSA-infected wound healing.

Drug Interactions in Diabetic Ulcer Patients in an Indonesian Private Hospital

Diabetic ulcers can progress into tissue death, or gangrene, which create a risk for amputation. Measures for preventing other complications and accelerating wound healing in diabetic ulcers include blood sugar level control, diet adjustment, wound care, antidiabetic drug administration, and comorbid therapy. This leads to the use of various drugs that can potentially trigger drug interactions. This study aimed to identify possible drug interactions in the therapeutic management of diabetic ulcer patients treated in Husada Utama Hospital Surabaya, Indonesia, from January 2020–June 2022. This was a descriptive observational study using retrospective data from medical records. Results showed that 103 types of drugs were administered to 48 research samples with 41 of them experienced drug interactions (n=263 cases). Based on the severity of drug interactions, 31 cases were categorized as major cases (11.79%), with drug-class antibiotic-antiemetic interactions as the most frequent interactions. This study proves that it is essential for doctors and pharmacists.

RECOMBINANT HUMAN EPIDERMAL GROWTH FACTOR IN TREATING DIABETIC FOOT ULCERS-A RANDOMISED CONTROLLED TRIAL

Background: Diabetic foot ulcers are among the most common complications in patients with poor glycemic control. Diabetic foot ulcers are the result of poor glycemic control, underlying neuropathy, peripheral vascular disease, or poor foot care. Diabetic foot ulcers are a debilitating complication of diabetes mellitus that leads to increased overall morbidity in patients. When the recombinant human epidermal growth factor (rhEGF) is used as the topical application it stimulates epithelial proliferation, differentiation, and migration. As a result of this, there is an acceleration of epithelial regeneration and wound healing of diabetic ulcers. The Aim and Objective: aim is to study the efcacy of recombinant human epidermal growth factor by comparing the time taken for healing, cost-effectiveness, patient compliance, and duration of hospital stay after topical application of epidermal growth factor over a control group treated with conventional dressings of saline and hydrogen peroxide, which acts as the control group. This study is a randomized controlled trial conducted in the Methods: Department of General Surgery, Kanyakumari Government Medical College, from September 2022 to February 2023. A total of 60 patients were divided into two groups: 30 patients in the interventional group treated with rhEGF and 30 patients in the control group receiving conventional dressings with saline and hydrogen peroxide were monitored, and the wound healing time, patient compliance, cost effectiveness, and duration of hospital stay were studied. A total of Results: 60 patients of which 38 (63.3%) were males and 22(36.6%) were female patients. The wound healing was better in the group treated with rhEGF and the duration of hospital stay was signicantly shorter. Patient compliance was found to be similar in both groups &amp; conventional wound dressing was found to be cost effective as rhEGF topical application is a costly affair. This study suggests that recombinant human Conclusion: epidermal growth factor helps in the acceleration of epithelial regeneration and wound healing in diabetic ulcers. Patients who were treated with recombinant human epidermal growth factor had a signicant reduction in wound healing time and decreased duration of hospital stay.

Exploring Metformin as the Potential Oral Antidiabetic of Choice for Type II Diabetes Mellitus with Wound Comorbid: A Case-based Literature Review

Diabetes is a metabolic disease characterized by hyperglycemia caused by a disruption in insulin secretion, insulin function, or both. An individual with diabetes have a greater likelihood to develop chronic non-healing wounds, and if untreated, various chronic complications are associated with psychiatric stress and depression. In diabetic wounds, the inflammatory phase becomes persistent and excessive with impaired cell proliferation and greater risk of infection. Several studies have shown that metformin has potential effect for diabetic wound healing. Here, we reported a case of diabetic wound in East Jangkat, a rural area in Indonesia, with premorbid type 2 diabetes mellitus and obesity class II with a deeper discussion about the potential effect of metformin for wound healing in diabetic ulcers.

Conductive hydrogels with hierarchical biofilm inhibition capability accelerate diabetic ulcer healing

Diabetic ulcers (DUs) are characterized by massive biofilm formation, long-term inflammatory infiltration, and difficulty in healing. Electrical stimulation (ES) applied through hydrogel dressings is promising to treat DUs, but the development of advanced hydrogels with stable conductivity and effective antibacterial properties remains challenging. Loading antibiotics in hydrogels by absorption is prone to the initial burst release, which is associated with frequent dressing changes and bacterial resistance development. Herein, antibacterial terbium ions are incorporated into the hydrogel network by coordination interactions for sustainable release. Agarose and zwitterions are used to prevent protein absorption and bacterial adhesion due to their strong hydration ability. The combination of the antifouling components and bactericidal terbium ions in the hydrogel results in a tremendous antibacterial effect, which completely inhibits biofilm formation by Staphylococcus aureus and Escherichia coli. Polypyrrole is also covalently grafted to the hydrogel network, providing stable and biomimetic conductivity. When ES is applied through the hydrogel, the antibacterial hydrogel controls the inflammation induced by infection and the applied ES helps DUs pass the proliferation stage, and thus accelerates wound healing.

Design, development, in-vitro and in-vivo evaluation of polylactic acid-based multifunctional nanofibrous patches for efficient healing of diabetic wounds

Impaired healing of diabetic ulcers is one of the major complications of diabetic patients due to high susceptibility to microbial infections, impaired lymphianogenesis, edema, and consequently impairing proper healing. This could even lead to much worse complications that include severe gangrene, trauma and finally limb amputation. Therefore, this study aims to develop a multilayered durable nanofibrous wound patch loaded with three promising drugs (phenytoin, sildenafil citrate and simvastatin) each in a separate layer to target a different wound healing phase. Polylactic acid was used for the preparation of the nanofibrous matrix of the wound patch, where each drug was incorporated in a separate layer during the preparation process. Drugs release profiles were studied over 3 weeks. Results showed that both phenytoin and simvastatin were released within 14 days while sildenafil continued till 21 days. Both physicochemical and mechanical characteristics of the patches were fully assessed as well as their biodegradability, swellability, breathability and porosity. Results showed that incorporation of drugs preserved the physicochemical and mechanical properties as well as porosity of the developed nanofibers. In addition, patches were evaluated for their biocompatibility and cell adhesion capability before being tested through in-vivo diabetic wound rat model induced by alloxan for three weeks. In vivo results showed that the patches were successful in inducing proper wound healing in diabetic rat model with overcoming the above-mentioned obstacles within 3 weeks. This was confirmed through assessing wound closure as well as from histopathological studies that showed complete healing with proper cell regeneration and arrangement without forming scars.