Ulcer Healing Research Articles

Healing of induced tongue defects using erythropoietin hydrogel (an experimental study on rats)

BackgroundTongue is complex muscular organ that may be affected by recurrent or chronic ulcerations and malignances that require effective treatment to enhance healing and tissue regeneration. So, this study aimed to evaluate the efficiency of erythropoietin (EPO) hydrogel as an anti-inflammatory and an inducer of neovascularization during healing of induced rats’ tongue defects.MethodsThirty six rats were divided into three groups; Group I (negative control): tongues were left without ulceration and received no treatment, Group II (positive control): tongue defects were prepared on the tongues’ dorsal surfaces, measuring (5 mm × 2 mm) using a tissue punch rotary drill for standardization, and left untreated, Group III (EPO group): tongue defects were prepared as in group II, then injected circumferentially around wound margins with a single high dose of EPO hydrogel of 5000 U/kg on the day of defect preparation. Animals were euthanized on seventh and fourteenth days after treatment, tongue specimens were collected, and paraffin blocks were prepared and processed for histological assessment by hematoxylin and eosin stain and immunohistochemical evaluation of anti-iNOS and anti-VEGF followed by histomorphometrical analysis and the relevant statistical tests.ResultsAt both time points, the EPO treated group showed significantly enhanced tissue regeneration marked by the histologically better regenerated tissue with well developed, thick walled and well-organized blood vessels and significant reduction in defect depth compared to positive control group. EPO group also showed significant decrease in iNOS and significant increase in VEGF antibodies indicating its anti-inflammatory and neovascularization effects respectively.ConclusionEPO treatment can significantly accelerate regeneration and filling of tongue defects by reducing tissue inflammation and enhancing neovascularization. Therefore, EPO could be a potential therapeutic strategy for accelerating healing of tongue ulcers. However, further investigations are required to optimize the dose and unravel any potential side effects before its clinical application.

Effects of Photobiomodulation Therapy on the Expression of Hypoxic Inducible Factor, Vascular Endothelial Growth Factor, and Its Specific Receptor: A Randomized Control Trial in Patients with Diabetic Foot Ulcer.

Background: Impaired angiogenesis is a significant factor contributing to delayed healing in diabetic foot ulcers (DFUs) due to inadequate oxygenation. Objective: This study aimed to investigate the impact of photobiomodulation (PBM) using a Ga-As laser on the release of serum hypoxia-inducible factor 1-α (HIF-1α), vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-2, and nitric oxide (NO) in diabetic patients with DFUs. Materials and methods: In this double-blind RCT, a total of 30 patients with grade II DFUs were enrolled. The patients were randomly divided into two groups: the PBM (n = 15) and the placebo (n = 15). In the PBM group, a Ga-As laser (904 nm, 2 J/cm2, 90 W) was given for 3 days/week for 4 weeks (11 sessions). In the placebo group, the power was turned off. Both groups received similar standard wound care. Before and after interventions, the levels of serum HIF-1α, VEGF, NO, and sVEGFR-2 were measured. In addition, the percentage decrease in the wound surface area (%DWSA) was measured. Results: Following the intervention, the results revealed that the PBM group had significantly lower levels of VEGF than the placebo group (p = 0.005). The %DWSA was significantly higher in the PBM group compared to the placebo group (p = 0.003). Moreover, VEGF showed a significant negative correlation with %DWSA (p < 0.001). Conclusions: The observed decrease in serum levels of VEGF and an increase in %DWSA, compared to the placebo group, suggests that PBM effectively improves angiogenesis. Furthermore, the significant correlation found between VEGF levels and %DWSA emphasizes the importance of evaluating wound surface in patients as a dependable indicator of enhanced wound angiogenesis. Clinical Trial Registration: NCT02452086.

Therapeutic Effect of Silver Nanoparticles in the Management of Diabetic Ulcers: A Systematic Review and Meta-Analysis on RCTs.

The skin, as the body's largest organ, plays vital roles in sensory functions, temperature regulation, and protection against pathogens and injuries. Skin wounds, which disrupt its integrity, can result from various factors, including diseases such as diabetes. Diabetic foot ulcers are a severe complication of diabetes, often leading to amputations. This systematic review explores the therapeutic potential of silver nanoparticles in the management of diabetic ulcers. Seven studies published between 2016 and 2023 were included in this review. Also, 4 studies were included in the meta-analysis. These studies investigated the application of silver nanoparticles, primarily in dressing forms, for diabetic ulcer treatment. A systematic search strategy was employed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The results show that silver nanoparticles do not have a significant difference in improving DFU healing rates. SilvrSTAT Gel, a dressing containing silver nanoparticles, outperformed traditional dressings, leading to a substantial percentage of ulcers healing within weeks. Comparative studies also indicated that silver nanoparticles were at least as effective as alternative treatments, such as nano-chitosan dressings, and showed potential for combination therapy with growth factors. This review underscores the promise of silver nanoparticles, a nanotechnology-based approach, in accelerating the healing of diabetic ulcers while providing antimicrobial benefits. Despite some limitations, including variations in treatment regimens and a lack of long-term outcome data, these findings show there is no clinical evidence for using Nanosilver for the healing process of DFU. Silver nanoparticles currently do not have sufficient clinical evidence for healing the DFU; however, in some studies, they had noticeable effects on the rate of wound healing.

Effect of platelet-rich plasma on healing of lower extremity diabetic skin ulcers: A meta-analysis.

The aim of this research is to explore the therapeutic efficacy of platelet-rich plasma (PRP) on the cutaneous ulceration of diabetes mellitus (DM). From the beginning of the database until January 2024, we looked through several databases to obtain randomised, controlled PRP studies to treat the wound healing of DM in adult patients. The Cochrane Collaboration's Risk-Of-Bias Instrument was used to evaluate the risk of bias in randomised, controlled studies. Funnel plots, sensitivity analyses and Egger regression tests were employed to determine the reliability and effectiveness of the meta-analyses. Depending on the degree of heterogeneity, a fixed or random effect model has been used. The statistical significance was determined to be below 0.05. Altogether 281 trials were collected from the database and entered into Endnote Software for screening, and 15 trials were analysed. It was found that PRP was associated with a higher rate of wound healing (OR, 3.23; 95% CI, 2.42, 4.31 p < 0.0001). PRP was associated with a reduction in the risk of post-operative wound infection (OR, 0.46; 95% CI, 0.21, 0.99 p = 0.05). PRP was associated with a reduction in the risk of amputations amongst those with DM (OR, 0.50; 95% CI, 0.30, 0.84 p = 0.009). Overall, PRP treatment for DM is expected to improve the rate of wound healing, decrease the risk of wound infection and decrease the risk of amputations.

Therapeutic Efficacy of Cold Pressed Virgin Coconut Oil an Adjuvant to Conventional Therapy in Recurrent Aphthous Stomatitis -A Comparative Clinical Study

Introduction Oral health correlates with systemic health and maintaining oral health is very important as oral cavity is considered a reflection of the general wellbeing of human body. Recurrent aphthous stomatitis (RAS) is one of the most common painful oral mucosal conditions seen among childhood or adolescence. There are various topical and systemic agents available for the symptomatic relief of RAS, which if used for a long duration might cause various adverse effects. To overcome these adverse effects there are numerous natural remedies available used as an alternative therapies to treat RAS, one such natural and alternative therapeutic agent is Virgin Coconut oil (VCO). Material and Methods A total of 52 subjects were recruited for the study who are clinically diagnosed as RAS based on the family history, peak age of onset, site, size, number and frequency of ulcer. All the subjects were randomly (lottery method) divided into two groups-Group A (26 patients) and Group B (26 patients). In Group A, Subjects was given 150 ml VCO, In Group B, subjects were given 5% Amlexanox paste. Results The mean and standard deviation values and P values achieved from unpaired t test which stated that group A and group B differ in terms of length at day1 and day 5, and in breadth day 3 and day 5, and the difference is statistically significant. Results of friednan test analysis infer that there is statistically significant difference in terms of VAS score in different time intervals in group A. Values of manwhitney U test infers that they exists a statistically significant difference between group A and Group B in terms of VAS score at day 3 ( P value 0.003) and at day 5 ( P value 0.000). Conclusion The study established a highly statistical significant difference within the groups in healing of ulcer and pain reduction (p=0.00) in both group A and B. When the outcomes were compared between the groups, reduction in ulcer size (p=0.068) and pain (p=0.003*) was observed on the 3rd day. However a significant reduction in pain was present on the 5th day (p=0.000*) in group A, with significant reduction in ulcer size (p=0.000*). This study suggests that VCO could be used as an effective and safe alternative drug in management of signs and symptoms of RAS. Key Words Amlexanox paste, RAS, VCO

Investigation of regenerative nutrology of cells/molecules to the organism: a systematic review

Introduction: In the context of tissue regeneration and nutrology, stem cells from adult tissue mediate homeostasis and regeneration of tissues and organs. These decisions are directly integrated with the body's energy balance and nutritional status. Endogenous metabolites and dietary nutrients can directly influence epigenetic enzymes. Objective: It was to carry out a systematic review of the regenerative nutrology of cells and molecules in the body. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to June 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. A total of 45 articles were evaluated in full and 25 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 18 studies that did not meet GRADE. It was evidenced that the metabolism of stem cells was centered on the central metabolism of carbon and the balance between glycolysis versus oxidative phosphorylation in the regulation of cell destiny. Epigenetic modifications to DNA and histones, proteins that alter cellular fate, control chromatin accessibility and downstream gene expression. In addition to the connection between metabolism and epigenetic pathways, nutrients can impact cellular status by modulating signaling pathway activity. A clear example is through the mechanistic targeting of the rapamycin (mTOR) signaling pathway, and in particular the mTOR 1 complex. Nutritional supplementation accelerated the healing of skin ulcers and reduced the intensity of wound care in non-malnourished patients.

O17: ‘I had to do something’: A qualitative study of patients and healthcare professionals engagement in an interventional diabetic foot ulcer trial

Abstract Background Development of interventions to improve diabetic foot ulcer(DFU) healing is vital, however trials typically under-recruit and translation of effective interventions is limited. This study explores patient and clinician perceptions of Extracorporeal Shockwave Therapy(ESWT) and the SOLEFUL Trial(randomised control trial of ESWT for DFU). Methods Maximum variable sampling technique was used to recruit participants from one tertiary centre and clinicians nationally. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim in four participant groups (participants, dropouts, decliners, and clinicians). Data were analysed with an inductive exploratory approach using reflexive thematic analysis. Results 18 participants, 1 dropout, 3 decliners and 10 clinicians took part. Drivers for participation included desperation for healing and curiosity in a new intervention. Participants perceived the trial offered holistic healthcare, referencing quality-of-life questionnaires and telephone follow-ups. ESWT was viewed as hassle-free and painless, compared to alternatives. Barriers to participation included impact of competing comorbidities and belief care cannot be improved. In contrast, clinicians discussed mechanisms of action, effectiveness, and implementation of new technologies. Conclusion This study highlighted key drivers for trial engagement/disengagement in patients with DFUs and their clinicians. These factors must be respected in trial design and delivery to aid successful development of new DFU interventions.

Comparison of vonoprazan and proton pump inhibitors for the treatment of gastric endoscopic submucosal dissection-induced ulcer: an updated systematic review and meta-analysis

BackgroundBoth vonoprazan and proton pump inhibitors (PPIs) are currently used to treat artificial ulcers after gastric endoscopic submucosal dissection. However, evidence-based medicine proving the efficacy of vonoprazan is still lacking. Therefore, this meta-analysis aimed to compare the efficacy of vonoprazan and PPIs for the treatment of artificial ulcers after gastric endoscopic submucosal dissection.MethodsThe PubMed, EMBASE and Cochrane Library databases were searched up to September 2023 for related randomized controlled trials (RCTs). RCTs that compared the efficacy of vonoprazan and PPIs in treating artificial gastric ulcers after gastric endoscopic submucosal dissection were included. Two independent reviewers screened the included studies, extracted the data and assessed the risk of bias. The following outcomes were extracted for comparison: ulcer healing rate, ulcer shrinkage rate, delayed postoperative bleeding rate, and ulcer perforation rate.ResultsNine randomized controlled trials involving 926 patients were included. The pooled results showed that vonoprazan had a significantly lower rate of delayed postoperative bleeding than did PPIs (RR = 0.46; 95% CI = 0.23–0.91; P = 0.03). No significant differences were found in terms of ulcer healing, shrinkage rates, or ulcer perforation rates between vonoprazan and PPIs.ConclusionsCompared with PPIs, vonoprazan is superior at reducing delayed postoperative bleeding after endoscopic submucosal dissection. However, further studies are needed to prove the efficacy of vonoprazan.Systematic Review RegistrationIdentifier CRD42024509227.

Offloading systems for the treatment of neuropathic foot ulcers in patients with diabetes mellitus: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome. The present MA includes randomized controlled studies (duration > 12weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing. A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p = 0.04, I2 = 0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p = 0.002, I2 = 51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p = 0.008, I2 = 0%). Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary.

An Antibiotic Nanobomb Constructed from pH-Responsive Chemical Bonds in Metal-Phenolic Network Nanoparticles for Biofilm Eradication and Corneal Ulcer Healing.

In the treatment of refractory corneal ulcers caused by Pseudomonas aeruginosa, antibacterial drugs delivery faces the drawbacks of low permeability and short ocular surface retention time. Hence, novel positively-charged modular nanoparticles (NPs) are developed to load tobramycin (TOB) through a one-step self-assembly method based on metal-phenolic network and Schiff base reaction using 3,4,5-trihydroxybenzaldehyde (THBA), ε-poly-ʟ-lysine (EPL), and Cu2+ as matrix components. In vitro antibacterial test demonstrates that THBA-Cu-TOB NPs exhibit efficient instantaneous sterilization owing to the rapid pH responsiveness to bacterial infections. Notably, only 2.6µgmL-1 TOP is needed to eradicate P. aeruginosa biofilm in the nano-formed THBA-Cu-TOB owing to the greatly enhanced penetration, which is only 1.6% the concentration of free TOB (160µgmL-1). In animal experiments, THBA-Cu-TOB NPs show significant advantages in ocular surface retention, corneal permeability, rapid sterilization, and inflammation elimination. Based on molecular biology analysis, the toll-like receptor 4 and nuclear factor kappa B signaling pathways are greatly downregulated as well as the reduction of inflammatory cytokines secretions. Such a simple and modular strategy in constructing nano-drug delivery platform offers a new idea for toxicity reduction, physiological barrier penetration, and intelligent drug delivery.

Madhumehajanya Dusta Vrana - Ayurvedic management

Prameha is one of the Ashtamahagada occurring mainly due to Santarpana nidanas involving ten dushyas, which eventually results into Madhumeha. Due to improper management, complications occur in the form of Prameha Pidakas which if further untreated results into Madhumehajanya dusta vrana. Pramehajanya dusta vrana can be co-related to Diabetes Mellitus (DM) and Diabetes Foot ulcer respectively in contempoary science. This paper disscuss the management of diabetic foot ulcer patient who have been taking allopathic medicine for long time and have been suffering from chronic non healing ulcer in lower limb managed using different agada yogas mentioned in Ayurveda along with Jaluka proyoga

Antibacterial, ROS scavenging and angiogenesis promoting ϵ-Polylysine/gelatin based hydrogel containing CTLP to regulate macrophages for pressure ulcer healing

Pressure ulcers (PUs) have emerged as a substantial burden on individuals and society. The introduction of innovative dressings that facilitate the healing of pressure ulcer wounds represents a cost-effective alternative for treatment. In this study, the emphasis is on the preparation of Carthamus tinctorius L. polysaccharide (CTLP) as hydrogel microspheres (MPs), which are then encapsulated within a hydrogel matrix crosslinked with phenylboronic acid gelatin (Gelatin-PBA) and ϵ-polylysine-grafted catechol (ϵ-PL-Cat) to enable sustained release for promoting pressure ulcer healing. The presented Gelatin-PBA/ϵ-PL-Cat (GPL)/CTLP-MPs hydrogel demonstrated outstanding self-healing properties. In addition, in vitro experiments revealed that the hydrogel exhibited remarkable antibacterial activity, excellent biocompatibility. And it showed the capacity to promote vascular formation, effectively scavenge reactive oxygen species, and facilitate macrophage polarization from the M1 to M2 phenotype. In vivo wound healing of mice PUs indicated that the prepared GPL/CTLP-MPs hydrogel effectively accelerated the formation of granulation tissue and facilitated the healing of the wounds. In summary, in vivo and in vitro experiments consistently highlight the therapeutic potential of GPL/CTLP-MPs hydrogel in facilitating the healing process of PUs.

Tibial cortex transverse transport promotes ischemic diabetic foot ulcer healing via enhanced angiogenesis and inflammation modulation in a novel rat model

BackgroundTibial Cortex Transverse Transport (TTT) represents an innovative surgical method for treating lower extremity diabetic foot ulcers (DFUs), yet its underlying mechanisms remain elusive. Establishing an animal model that closely mirrors clinical scenarios is both critical and novel for elucidating the mechanisms of TTT.MethodsWe established a diabetic rat model with induced hindlimb ischemia to mimic the clinical manifestation of DFUs. TTT was applied using an external fixator for regulated bone movement. Treatment efficacy was evaluated through wound healing assessments, histological analyses, and immunohistochemical techniques to elucidate biological processes.ResultsThe TTT group demonstrated expedited wound healing, improved skin tissue regeneration, and diminished inflammation relative to controls. Marked neovascularization and upregulation of angiogenic factors were observed, with the HIF-1α/SDF-1/CXCR4 pathway and an increase in EPCs being pivotal in these processes. A transition toward anti-inflammatory M2 macrophages indicated TTT's immunomodulatory capacity.ConclusionOur innovative rat model effectively demonstrates the therapeutic potential of TTT in treating DFUs. We identified TTT's roles in promoting angiogenesis and modulating the immune system. This paves the way for further in-depth research and potential clinical applications to improve DFU management strategies.

Adhesive hydrogel releases protocatechualdehyde-Fe3+ complex to promote three healing stages for accelerated therapy of oral ulcers

Oral ulcers can significantly reduce the life quality of patients and even lead to malignant transformations. Local treatments using topical agents are often ineffective because of the wet and dynamic environment of the oral cavity. Current clinical treatments for oral ulcers, such as corticosteroids, have limitations and side effects for long-term usage. Here, we develop adhesive hydrogel patches (AHPs) that effectively promote the healing of oral ulcers in a rat model. The AHPs are comprised of the quaternary ammonium salt of chitosan, aldehyde-functionalized hyaluronic acid, and a tridentate complex of protocatechualdehyde and Fe3+ (PF). The AHPs exhibit tunable mechanical properties, self-healing ability, and wet adhesion on the oral mucosa. Through controlling the formula of the AHPs, PF released from the AHPs in a temporal manner. We further show that the AHPs have good biocompatibility and the capability to heal oral ulcers rapidly. Both in vitro and in vivo experiments indicate that the PF released from AHPs facilitated ulcer healing by suppressing inflammation, promoting macrophage polarization, enhancing cell proliferation, and inducing epithelial-mesenchymal transition involving inflammation, proliferation, and maturation stages. This study provides insights into the healing of oral ulcers and presents an effective therapeutic biomaterial for the treatment of oral ulcers. STATEMENT OF SIGNIFICANCE: By addressing the challenges associated with current clinical treatments for oral ulcers, the development of adhesive hydrogel patches (AHPs) presents an effective approach. These AHPs possess unique properties, such as tunable mechanical characteristics, self-healing ability, and strong adhesion to the mucosa. Through controlled release of protocatechualdehyde-Fe3+ complex, the AHPs facilitate the healing process by suppressing inflammation, promoting cell proliferation, and inducing epithelial-mesenchymal transition. The study not only provides valuable insights into the healing mechanisms of oral ulcers but also introduces a promising therapeutic biomaterial. This work holds significant scientific interest and demonstrates the potential to greatly improve the treatment outcomes and quality of life for individuals suffering from oral ulcers.

Facilitating Healing in Diabetic Foot Ulcers Using Homeopathy in a Multi-Disciplinary Integrative Approach: Two Evidence-Based Case Reports.

A rising incidence of diabetic foot ulcers (DFUs) in India has escalated the rate of lower limb amputations in the country. The present study aims to evaluate the potential healing properties of homeopathic medicines as a part of the integrative management of DFUs through two evidence-based case reports. Two patients with DFUs, identified as Wagner grade 2, having had diabetes for 12 years, were treated with individualized homeopathic medicine within a multi-disciplinary approach. Both cases were on oral hypoglycemic agents for managing blood sugar, continued their diabetic medication, and were advised to use regular wound dressings. The DFUs were assessed using the Pressure Ulcer Scale for Healing (PUSH) score at baseline and every 4 weeks until complete wound healing. Neuropathic changes were evaluated by the 10g monofilament tactile test, and the Modified Naranjo Criteria for Homeopathy-Causal Attribution Inventory (MONARCH) tool was used to assess the likelihood of there being a causal relationship between clinical improvement and the homeopathic intervention. The DFUs showed healing within 12 weeks, with a significant improvement in the PUSH score, though there was no change in tactile sensation as assessed by the monofilament test. The MONARCH tool yielded +9 in both cases, indicating the likelihood of a causal relationship between the clinical outcome and homeopathic intervention. The homeopathic medicines Arsenicum album and Lachesis respectively were found useful by each patient. Homeopathy appeared beneficial in facilitating the early healing of DFUs within a multi-disciplinary integrative approach.

Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study

BackgroundThe optimal treatment approach for patients with active venous leg ulcers (VLUs) and post-thrombotic syndrome (PTS) associated with great saphenous vein (GSV) reflux remains unclear. To address this gap, we retrospectively compared the outcomes of patients with post-thrombotic VLU with an intact GSV vs those with a stripped or ablated GSV. MethodsWe retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups—group A (with an intact GSV) and group B (with a stripped or ablated GSV)—were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period. ResultsThere were no significant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post-thrombotic changes. Group A had significantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) (P = .008). Group A also exhibited a significantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) (P = .0177), with a greater probability of ulcer healing (P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was significantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) (P = .0009). In addition, in a subgroup analysis, patients with an intact but refluxing GSV (12 of 34) had a significantly shorter time to heal (median: 34 days, IQR: 57.25) (P = .0242), with a greater probability of ulcer healing (P = .0091) and significantly fewer recurrences (2 of 12, 16%) (P = .006) compared with group B. ConclusionsOur findings suggest that removal of the GSV through stripping or ablation in patients with post-thrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the refluxing GSV was left untreated. These findings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population.

Effectiveness of glutamine and arginine in wound healing of pressure ulcers: A systematic review protocol

IntroductionVarious nutrients play a physiological role in the healing process of pressure ulcers (PUs). Nutritional interventions include the administration of enteral nutritional supplements and formulas containing arginine, glutamine, and micronutrients. The aim of this systematic review is to evaluate the effectiveness of enteral nutritional supplements and formulas containing arginine and glutamine on wound-related outcomes. These include (1) time to healing, (2) changes in wound size, (3) local wound infection, (4) PU recurrence, and (5) PU-related pain. Materials and methodsThis protocol was developed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A search will be conducted in the Cochrane Library, EMBASE, PubMed (MEDLINE), CINAHL (EBSCOhost interface) and Web of Science. In addition, a manual search will be conducted to identify relevant records. Except for systematic reviews, no restrictions will be placed on the study design, the population studied or the setting. Studies that do not address PUs, in vitro studies and studies that do not report wound-related outcomes will be excluded. Study selection, risk of bias assessment and data extraction will be performed independently by three researchers. Depending on the extent of heterogeneity of interventions, follow-up time and populations, results will be summarised either by meta-analysis or narrative synthesis. ConclusionsThis is the first systematic review to identify, evaluate and summarise the current evidence for enteral arginine and glutamine supplementation on wound-related outcomes in PUs. The review will provide a solid basis for deriving valid and clinically relevant conclusions in this area.

Radiofrequency ablation versus stripping of great saphenous vein in the management of varicose veins

Background: Varicose veins are defined as dilated, tortuous subdermal veins &gt;3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P&lt;0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group.

Pancreatic Tuberculosis With Duodenal Fistula Presenting as Life-Threatening Gastrointestinal Bleeding

ABSTRACT Pancreatic tuberculosis (TB) warrants heightened suspicion in individuals with pancreatic lesions and risk factors such as HIV, organ transplantation, or pertinent immigration history. We present a 38-year-old man who presented with hemodynamically unstable gastrointestinal bleeding. He was found to have pancreatic TB complicated by a duodenal ulcer with fistula. Following 1 month of antitubercular therapy, he experienced complete resolution of symptoms, healing of the duodenal ulcer, closure of the fistulous tract, and a decrease in the size of the pancreatic lesion as observed on imaging. Our case highlights the importance of early diagnosis and treatment of pancreatic TB.

The effect of traditional Chinese medicine soaking method on the healing of diabetic foot ulcers: A meta-analysis.

Foot infections, sores or deep tissue damage from diabetes can be a serious psychological and physical injury. This paper aims at making meta-analyses on the therapeutic effects of traditional Chinese medicine (TCM) on diabetic foot ulcers. The Chinese National Knowledge Infrastructure, VIP Database, Wanfang Database and so on, has conducted a randomized controlled trial to evaluate the clinical effect of TCM soaking method for diabetes patients with diabetes. Literature has been determined to be included by computer search and by hand rough checks. The search period was from the creation of the database to October 2023. Review Manager 5.3 was used to analyse the meta data and evaluate it systematically. Altogether, 479 research was conducted in China's data base and 20 of them were eventually collected for the final statistical analysis. In all, 1361 patients were enrolled in the trials. The results indicated that TCM immersion in diabetic foot resulted in significantly improved obvious wound healing (OR, 3.2; 95% CI, 2.5, 4.09, p < 0.0001); results showed that TCM immersion therapy significantly increased the efficiency of effective wound healing (OR, 4.55; 95% CI, 3.25, 6.37, p < 0.001). Statistical significance was found. Using Egger's approach to detect publishing bias suggests that there is no risk of publishing bias in terms of marked wound healing and effective healing. Traditional Chinese drug immersion can increase obviously the recovery ratio and the effective recovery ratio of diabetic foot.