Management Of Ulcers Research Articles

Therapeutic management of non-perforating abomasal ulcer in cattle

Therapeutic management of non-perforating abomasal ulcer in cattle

Putting skin in the game: a descriptive study of lower extremity ulcers in general medical inpatients.

Lower extremity ulcers contribute a significant burden to patient care. Targeted investigation and management are pertinent to improving patient outcomes. We evaluated the aetiology, risk factors, investigations and management of lower extremity ulcers in general medicine patients. There was evidence of under-ordering of appropriate investigations, and over-treatment for infection. We proposed a quality improvement initiative to optimise lower extremity ulcer care.

Emerging technologies for the management of diabetic foot ulceration: a review

Diabetic foot ulcers (DFUs) and infections are common complications that frequently result in reduced quality of life and even morbidity for patients with diabetes. This paper highlights significant findings in DFU treatments and emerging advanced technologies for monitoring ulceration in patients with diabetes. The management of DFUs requires a multidisciplinary approach that involves patient education. It is well-established that poor glycemic control significantly contributes to diabetic foot ulcer complications, presenting global challenges in quality of life, economics, and resource allocation, affecting approximately half a billion people and potentially leading to lower limb amputation or mortality. Therefore, effective DFU management necessitates a multidisciplinary approach that includes patient education. However, current clinical guidelines for DFU treatment are not performing effectively, resulting in unnecessary increases in financial and emotional burden on patients. Researchers have experimented with advanced technologies and methods, including traditional approaches, to address complications related to DFU healing. This paper also presents the evolution of patents in the field of DFU medication and advanced diagnostic methods, showcasing relevant innovations that may benefit a wide range of researchers.

Management of Diabetic Foot Ulcer - A Case Report

Due to sedentary lifestyle of today, diabetes mellitus is becoming a common illness. One of the complications of diabetes mellitus, the primary cause of lower limb amputations, is diabetic foot ulcers. It affects 15% of all diabetes mellitus patients and occurs before lower limb amputation in 84% of people with diabetic foot ulcers. Controlling blood sugar levels, debridement, improved dressings, and offloading techniques are all necessary for the treatment of diabetic foot ulcers. Acharya Sushruta has listed sixty different forms of treatment in the Ayurvedic literature. He has placed particular emphasis on Vranashodhana and Ropana. Blood sugar management with Arogyavardhini Vati, wound debridement and appropriate wound care are all part of the treatment of diabetic foot ulcers. It took a month for the ulcer to fully heal, and throughout that time, the patient's ability to carry out daily tasks improved. The Ayurvedic treatment that was implemented has shown encouraging outcomes in the management of diabetic foot ulcer. It is imperative to conduct more randomised controlled trials in this area of study.

Efficacy of Cold Atmospheric Plasma in Chronic Diabetic Foot Ulcer Management: A Case Report

Efficacy of Cold Atmospheric Plasma in Chronic Diabetic Foot Ulcer Management: A Case Report

Topical Herbal Products as Adjuncts to Standard Care for the Management of Diabetic Foot Ulcers

Background and Aim: Diabetic foot ulcers (DFUs) constitute one of the most debilitating complications of diabetes mellitus (DM). The use of topical herbal products as adjuvant agents in wound dressing is one of the most widely used practices worldwide. The present review aimed to provide a detailed and comprehensive systematic review focusing on randomized clinical studies and critically analyze not only the clinical outcomes but also the methodological approaches used by these studies. Methods: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For the extraction of relevant studies, three databases were searched: Pubmed, Web of Science Core Collection, and Scopus by two independent researchers. Results: A search of the three databases resulted in the identification of 5528 records which were reduced to 3224 after removal of duplicates. The application of inclusion and exclusion criteria left 35 full-text articles assessed for eligibility. Finally, 13 articles were excluded and only 22 articles were advanced to the final analysis. Most studies reported details of local ulcer management only while others reported the additional systemic/surgical measures used for management. The present review identified 18 botanical agents/preparations used alone or in combination with other agents as adjuvant agents in treatment of DFUs. In most situations, these agents proved to be effective. Conclusion: The present review reported the methodological approaches and clinical outcomes of botanical extracts used topically for the treatment of diabetic foot ulcers in randomized controlled studies. These agents proved to be generally effective. However, many gaps existed in the study designs which may limit the evidence-based value of these studies.

Panchakarma in Parinaama Shoola - A Review Article

Parinama Shoola is a chronic, recurrent, and non-fatal gastrointestinal (GIT) condition, accounting for 25% of patient visits to clinics and hospitals in India.[1] In Ayurveda, Madhavakara was the first to describe Parinama Shoola, characterizing it as pain during digestion, and categorizing it as a Vata-Pradhana Tridoshaja Vyadhi.[2] Samprapti: The development of Shoola begins with the consumption of incompatible foods (Viruddhahara), such as hot and spicy rich fatty diets, junk foods, and habits like tobacco chewing, smoking, and alcohol consumption. Physical inactivity and mental stress further exacerbate the condition, leading to digestive impairment (Agnimandya) and the formation of toxins (Ama). This sequence of events progresses through stages of: Ajeerna (indigestion), Amlapitta (hyperacidity), finally culminating into Shoola (pain).[3] The causes, progression, and symptoms of Parinama Shoola are remarkably similar to those of duodenal ulcers in modern medical science. Management of duodenal ulcers typically involves: Educating the patient, Avoiding known causative factors, Prescribing bland diets, Using antacids and acid-blocking medications, Administering antibiotics for H. pylori infection. Despite these treatments, high recurrence rates and unwanted side effects are common. In Ayurvedic treatment for Parinama Shoola includes: Samshodhana (purification), Samshamana (pacification), Nidana Parivarjana (avoidance of causative factors), Pathya-Apathya (dietary and lifestyle modifications) and Prevention of recurrences. Ayurvedic medicines are noted for being cost-effective, easily available, and safe for long-term use.

Temporal and regional trends in Canada for the epidemiology and management of diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are a common downstream consequence of diabetes and pose significant concern to the health of affected individuals. There are currently limited data available that detail the epidemiology and inpatient burden of DFUs in Canada. This study aims to provide updated data on the epidemiological and economic burden of DFUs in Canada between 2015 and 2019. Using the Canadian Institute for Health Information Patient Cost Estimator the authors estimated, as the primary outcome, the number of DFU inpatient cases in Canada, the associated financial burden of these admissions on the Canadian healthcare system, physician compensation, and average patient length of hospitalisation. This analysis covered 12 Canadian jurisdictions and was stratified by age, sex, province and geographical region. The secondary outcome was to highlight temporal trends in the public health burden of DFUs by computing the average annual percentage change (AAPC; the weighted average of several annual percentage changes over multiple years) using Joinpoint (Surveillance Research Program National Cancer Institute, US) regression analysis. The total number of cases, average length of hospitalisation and physician costs across Canada were highest for patients over ≥60 years of age. By region, the total number of cases and standardised physician costs were highest in Central Canada, followed by Western Canada, and subsequently Eastern and Northern Canada. In 2019, there were >1800 patients with DFUs admitted to Canadian acute care hospitals. Despite having the lowest number of inpatient admissions, Northern Canada had the highest associated inpatient costs, followed by Central, then Western and, lastly, Eastern Canada. Overall, mean inpatient costs remained stable over time across all age groups (AAPC 0.61; 95% confidence interval: -1.87-3.15), with an average cost of >$10,000 CAD per case. Average physician cost across all jurisdictions was approximately $1000 CAD per case, with the mean hospitalisation time being nine days. The findings of this study emphasise the dynamic nature of the economic and epidemiological DFU burden in Canada, underscoring the need for targeted interventions, multidisciplinary care and evidence-based resource allocation for the optimal management of diabetes and DFUs.

Effective Management of Chronic Lower-Extremity Ulcers (CLEU) by Fu’s Subcutaneous Needling (FSN)

Effective Management of Chronic Lower-Extremity Ulcers (CLEU) by Fu’s Subcutaneous Needling (FSN)

The Clinical Management of Traumatic Palatal Ulcers in an Adolescent Patient: A Common Lesion in Mini-Implant-Assisted Rapid Maxillary Expansion

Background: This case report describes the clinical management of a traumatic palatal ulcer, a complication associated with mini-implant-assisted rapid maxillary expansion (MARPE). Case Report: A 13-year-old female patient with maxillary constriction underwent MARPE treatment using a custom acrylic expander anchored by four mini-implants. Despite proper planning and device design, the patient missed her first follow-up appointment and continued activations, resulting in tissue inflammation and embedding of the device. Upon examination, swelling and displacement of the cement were observed, necessitating device removal. The traumatic ulcer was treated with chlorhexidine gel, paracetamol, and a soft diet. Complete recovery was achieved within one month. A second expander was then designed and installed, with more frequent monitoring and improved hygiene protocols. This approach led to successful expansion without complications. This case highlights the importance of precise treatment planning, proper mini-implant selection, and regular follow-ups in MARPE therapy. It also emphasizes the need for patient compliance and effective hygiene measures to prevent complications. Conclusions: The successful management of the traumatic ulcer demonstrates that prompt action and consideration of cost-effective treatment options can lead to positive outcomes in addressing MARPE-related complications.

Oxygen-Bonded Amorphous Transition Metal Dichalcogenides with pH-Responsive Reactive Oxygen Biocatalysis for Combined Antibacterial and Anti-inflammatory Therapies in Diabetic Wound Healing.

Diabetic wound healing is a formidable challenge, often complicated by biofilms, immune dysregulation, and hindered vascularization within the wound environments. The intricate interplay of these microenvironmental factors has been a significant oversight in the evolution of therapeutic strategies. Herein, the design of an efficient and versatile oxygen-bonded amorphous transition metal dichalcogenide biocatalyst (aRuS-Or) with pH-responsive reactive oxygen biocatalysis for combined antibacterial and anti-inflammatory therapies in promoting diabetic wound healing is reported. Leveraging the incorporation of Ru─O bonds, aRuS-Or exhibits optimized adsorption/desorption behavior of oxygen intermediates, thereby enhancing both the reactive oxygen species (ROS) generation activity in acidic conditions and ROS scavenging performance in neutral environments. Remarkably, aRuS-Or demonstrates exceptional bactericidal potency within infected milieus through biocatalytic ROS generation. Beyond its antimicrobial capability, post-eradication, aRuS-Or serves a dual role in mitigating oxidative stress in inflammatory wounds, providing robust cellular protection and fostering an M2-phenotype polarization of macrophages, which is pivotal for accelerating the wound repair process. The findings underscore the multifaceted efficacy of aRuS-Or, which harmoniously integrates high antibacterial action with anti-inflammatory and pro-angiogenic properties. This triad of functionalities positions aRuS-Or as a promising candidate for the comprehensive management of complex diabetic ulcers, addressing the unmet needs in the current therapeutics.

Modelling the cost-effectiveness of a chloramine gel in treating infected, non-healing diabetic foot ulcers.

Organic chloramines have been developed as a topical wound bed preparation gel. This study aimed to estimate whether the addition of chloramine gel (Chlorasolv, RLS Global AB, Sweden) to standard care compared with standard care alone would afford a cost‑effective technology to the UK's health services for treating infected, non-healing diabetic foot ulcers (DFUs). A Markov model was developed to simulate the management of infected, non-healing DFUs. The model utilised data from a randomised controlled trial and was used to estimate the cost-effectiveness of chloramine plus standard care compared with standard care alone over a period of 24 weeks, expressed as the incremental cost per quality-adjusted life year (QALY) gained at 2021/22 prices. Using adjunctive chloramine to treat infected, non-healing DFUs was found to shorten the time to healing by 36% (from a mean of 17.1 weeks per ulcer to a mean of 11.0 weeks per ulcer). This translated into a 6% improvement in the probability of being healed by 24 weeks and a corresponding 3% improvement in health-related quality of life (HRQoL). Also, use of adjunctive chloramine was found to reduce the total cost of ulcer management by 13%. Sensitivity analysis found that adjunctive chloramine remained a cost-effective treatment, even when the value of the model inputs was varied by ±20%. Within the limitations of the study, treatment with adjunctive chloramine instead of standard care alone could potentially afford the UK's health services a cost-effective debridement strategy for infected, non-healing DFUs, due to its ability to accelerate the time to healing.

Personalized and predictive strategies for diabetic foot ulcer prevention and therapeutic management: potential improvements through introducing Artificial Intelligence and wearable technology.

Diabetic foot ulcers represent a serious and costly complication of diabetes, with significant morbidity and mortality. The purpose of this study was to explore advancements in Artificial Intelligence, and wearable technologies for the prevention and management of diabetic foot ulcers. Key findings indicate that Artificial Intelligence-driven predictive analytics can identify early signs of diabetic foot ulcers, enabling timely interventions. Wearable technologies, such as continuous glucose monitors, smart insoles, and temperature sensors, provide real-time monitoring and early warnings. These technologies promise to revolutionize diabetic foot ulcer prevention by offering personalized care plans and fostering a participatory healthcare model. However, the review also highlights challenges such as patient adherence, socioeconomic barriers, and the need for further research to validate these technologies' effectiveness. The integration of artificial intelligence and wearable technologies holds the potential to significantly improve diabetic foot ulcer outcomes, reduce healthcare costs, and provide a more proactive and personalized approach to diabetic care. Further investments in digital infrastructure, healthcare provider training, and addressing ethical considerations are essential for successful implementation.

A Comprehensive Approach for Diabetic Foot Ulcer Management

Objectives: This study aims to evaluate the efficacy of a comprehensive management plan in the treatment of diabetic foot ulcers (DFUs). Evaluating the effects of wound debridement on the outcomes of diabetic foot ulcers, advanced dressings, blood sugar control, and offloading strategies are the main objectives. The study also intends to investigate the function of surgery in managing chronic ulcers and preventing recurrences. The goal is to offer advice for managing DFUs optimally and lowering related morbidity based on evidence. Method: The intervention program includes techniques like wound debridement, advanced dressings, unloading modalities, blood sugar level control, and, where necessary, surgical treatments. Growth factors, electrical stimulation, negative pressure wound therapy, bio-engineered skin, and hyperbaric oxygen therapy are among the many treatments that are included. Regression models are among the statistical analyses used to assess the efficacy of the overall management strategy. Results: Significant findings are presented in the results section, which shows how the holistic management strategy improves DFU outcomes. Improved wound healing rates, reduced infection incidents, and enhanced patient-reported outcomes are highlighted. The results underscore the significance of maintaining blood sugar levels, wound debridement, and incorporating various therapeutic modalities in DFU management. Conclusion: This study concludes by recommending a thorough and interdisciplinary approach to DFU management. Maintaining blood sugar levels, debridement of the wound, sophisticated dressings, unloading techniques, and surgical procedures are among the effective strategies that help reduce morbidity and prevent serious complications related to diabetic foot ulcers. Additional investigation is necessary to enhance and broaden these results for ongoing progress in the management of diabetic foot ulcers.

Tū Kaha: he mōhio ki ngā Māori o te kōmaoa waewae (Stand Strong: A qualitative study of Māori with venous leg ulcers in Aotearoa New Zealand).

Venous leg ulcers have impact on people's lives far beyond that of a skin lesion but these impacts have not been explored from an Indigenous perspective. We used a Māori-centered narrative approach to interview 13 Māori in Aotearoa New Zealand with venous leg ulcers. Data analysis was informed by a reflexive thematic approach and four themes were identified: Ko waewae ahau (I wear the leg); Ngā mea hōhā (annoying things); Ka tangi te ngākau (heartfelt grief); and Mamae (pain, sore, hurt). Recognizing patients' expertise in their condition, the inclusion of whānau (family) in care planning and provision, while providing consistent advice and resource access, would all enhance the experience of venous ulcer management. Training in venous leg ulcer care needs to move beyond a focus on the leg and toward a more holistic approach that encompasses a broader understanding of patient experiences and cultural contexts when managing venous ulcers.

The Role of Nutrition in the Nursing Management of Pressure Ulcers in Adult Community Settings: A Systematic Review Protocol.

The aging population drives a growing demand for care, particularly in Europe. It is estimated that approximately 1.5-2 million individuals have a chronic wound. Among these, pressure ulcers (PUs) are one of the most prevalent complications in vulnerable individuals. Malnutrition is a primary risk factor, yet it can be mitigated through proper nutrition and adequate community support. The community nurse plays a crucial role in managing chronic conditions and nutrition through constant and professional monitoring. This article presents a comprehensive systematic review (SR) protocol to examine the role of community nursing of nutritional intervention of frail population with wound care. A SR will be conducted according to international standards and reported following the PRISMA Guidelines for SRs. The search will be conducted in PubMed/Medline, Scopus, Embase, and CINAHL, supplemented by grey literature sources. The methodological quality and risk of bias will be assessed using the Critical Appraisal Skills Programme (CASP) framework. The protocol has been registered in the Open Science Framework (OSF). It is anticipated that the findings of this SR will provide new evidence on the relationships between nutritional nursing interventions and wound care management primarily in the community setting.

Utilization of traditional Chinese medicine in the management of cutaneous ulceration induced by cervical lymph node metastasis in tonsillar carcinoma: A case report

ObjectiveCutaneous ulcers induced by metastasis present a challenging clinical issue, often resistant to conventional dressing change interventions. In this case, we demonstrates the efficacy of Traditional Chinese Medicine in managing ruptured tumors. Case presentationWe present a case study of a 40-year-old Chinese male patient diagnosed with advanced tonsillar squamous cell carcinoma with cervical lymph node metastasis and cutaneous ulceration. Despite nearly six months of conventional dressing treatment yielding minimal improvement, significant healing of the ulcerated surface of the neck metastasis was observed after approximately two months of decoction therapy. The cancerous lesion exhibited a reduction of nearly 90 %, with concomitant alleviation of secondly symptoms such as cold intolerance, excessive sweating, anxiety and depression. ConclusionsIn this case, we introduces Traditional Chinese Medicine may be an effective alternative therapy for the treatment of cancer-related disease. And it may also be an optional therapeutic approach for healthcare practitioners with cutaneous carcinoma ulceration.

Evaluation of Antiulcer Activity of Hydroalcohol Extract of Peel of <i>Musa balbisiana</i> Fruits by a New Apparatus and Model

Background: Ulcers, a prevalent gastrointestinal disorder, impose significant health burdens worldwide. There are lots of market antiulcer drugs to treat the ulcer , but due to lots of their side effects and high cost, the utility of herbal medicines is increasing day by day. Traditional experimental in vivo approaches involve animal sacrifice, raising ethical concerns, while in vitro models do not show the antiulcer effect directly on the tissue. In response, our study developed a non-invasive model, eliminating the need for animal sacrifice while ensuring reliable results. Aim: This study explored the potential antiulcer properties of Musa balbisiana fruit peel hydroalcohol extract, utilising a novel apparatus and an animal crueltyfree model. Methods: Musa balbisiana fruit peel hydroalcohol extract 400 mg as a test drug and marketed Digene tablets as a standard were assessed using the developed model, and ulcer parameters were evaluated through innovative apparatus measurements. Results: In the blue index analysis, tissue treated with Ringer-Locke’s salt solution, Ringer-Locke’s salt solution + HCl, Ringer-Locke’s salt solution with Digene 400 mg + HCl, Ringer-Locke’s salt solution with M. balbisiana fruit peel hydroalcohol extract 400 mg + HCl showed the blue index of respective values of 52.95, 83.42, 64.48, and 65.51. Conclusion: The research results demonstrated promising antiulcer effects as compared to control and standard when blue indexes are measured, suggesting the potential therapeutic value of M. balbisiana fruit peel in ulcer management. Furthermore, the utilisation of a non-invasive model underscores its applicability in ethical research practices, fostering.

Trimetazidine protects against acute indomethacin-induced gastric mucosal, hepatic, and renal injury in rats

Background: Peptic ulcers are increasingly reported as a challenging disease in clinical settings. Several medications are employed in the management of peptic ulcers. Thus far, there is no medication devoid of any adverse effects that may achieve a 100% curative rate or provide a total remedy for the ailment. Aim: We aimed to examine the healing effects of trimetazidine against indomethacin-induced gastric ulcers in albino rats. Methodology: A total of 25 rats were used, divided into five groups (each group contained five rats): a negative control group that was only treated with distilled water, a positive control group that was only treated with a single dose of indomethacin (30 mg/kg) orally, a group that received indomethacin (30 mg/kg) and low doses of trimetazidine (17.5 mg/kg) orally, a group that received indomethacin (30 mg/kg) and medium doses of trimetazidine (35 mg/kg) orally, and a group that received indomethacin (30 mg/kg) and high doses of trimetazidine (52.5 mg/kg) orally. The induction of gastric ulcers occurred on the first day of the experiment through the administered indomethacin and, subsequently, the rats were treated orally with either trimetazidine or distilled water, three times daily, for 7 days. Serum urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin levels were measured. Stomachs were excised from the rats’ bodies and opened along the greater curvature; they were then rinsed with saline, extended on a white corkboard, and examined macroscopically. The stomach tissues were also processed in order to generate microscopic slides for microscopical examination. Results: Indomethacin administration caused multiple ulcerations in the gastric mucosa, significant elevations in serum urea, creatinine, AST, and ALT levels, and a significant reduction of the serum albumin levels. The treatment with trimetazidine significantly healed the indomethacin-induced gastric ulcers. Conclusion: The present study indicates that the nonsteroidal anti-inflammatory drug (NSAID) indomethacin can induce substantial gastric ulcers, which may be linked to a direct toxic effect on the histological architecture of the gastric linings in addition to the reduction of blood flow to gastric mucosa; this effect can be treated by administration of trimetazidine. Ultimately, this study suggests that administering the optimal dosage of trimetazidine can be advantageous in treating stomach ulcers caused by NSAIDs. Moreover, the study suggests that the indomethacin-induced liver and renal dysfunction can also be alleviated by the use of trimetazidine.

Study on the Management of Diabetic Foot Ulcer in Diabetic Patients at a Tertiary Care Hospital

AIM: To study the treatment pattern of diabetic foot ulcer and to assess the effect of patient counselling on diabetic foot ulcer patients. OBJECTIVE: 1. To study the various modalities of treatment used for Diabetic Foot Ulcer patients in a tertiary care hospital. 2. To assess the effect of patient counselling on diabetic foot ulcer patients with standard questionaries METHODS: The protocol was reviewed, revised, and approved by the Institutional Review Committee of MVJ Medical College and Research Hospital before commencement of the study. Over the course of six months, a tertiary care hospital conducted prospective research. Following the giving of written informed permission, diabetic patients with foot ulcers of both genders who were visiting the hospital were invited to participate and enrolled. A total of 150 patients participated in the study. The patients were recruited according to the inclusion and exclusion criteria mentioned. The study was attempted to improve the patient’s knowledge and attitude towards the self-management of diabetic foot ulcer. And thus, patient counselling is an essential component of clinical pharmacy practice in hospital. RESULTS: In this study, majority of the study participants belonged to the age group 61-70 years (30.7%) of age. 22% of the study participants were of the age group between 51-60 years of age. Majority (64.7%) of the study participants were males. In this study, Nottingham Assessment of Functional Footcare (Revised 2015) was used and an improvement in the total score was found i.e., from 18.27+5.85 before counselling jym oof ff\c b to 44.07+4.70 post counselling which was found to be statistically significant (P<0.001). Thus, a proper foot care education program has been shown to reduce the risk of ulceration. CONCLUSION: The present study was conducted to study the effect of patient counselling on diabetic foot ulcer patients using NAFFC score. Majority in the study belonged to 61-70 years and were males. Most of them had type 2 DM and grade 1 foot ulcer. In this study, Nottingham Assessment of Functional Footcare (Revised 2015) was used and an improvement in the total score was found i.e., from 18.27+5.85 before counselling to 44.07+4.70 post counselling which was found to be statistically significant (P<0.001). NAFFC score played an important role in the study to assess the functional outcome among diabetics with foot ulcers. Though there is development of new therapies for the management of diabetic foot ulcers, a high rate of failure ending with amputation still exists. Hence a counselling session to the diabetics with foot ulcers can prevent further complications.