Management Of Ulcers Research Articles

Comparative study between topical insulin, autologous serum, and honey-based eye drops as adjunctive treatment in resistant corneal ulcer

Background Resistant keratitis is a difficult situation faced every day in ophthalmology clinics. Resistance to healing may be attributed to many factors. Many adjunctive agents are widely used in a trial to accelerate healing and to prevent resistance to eliminate the chance of development of disabling complications. Purpose The aim of this study was to compare the effectiveness of topical insulin, autologous serum, and honey-based eye drops as adjunctive therapies in resistant corneal ulcers. Patients and methods This prospective study investigated 45 eyes of infected keratitis not responding to culture-based medical treatment for 2 weeks. The eyes were divided into three groups each of 15 eyes. The insulin group was treated with topical insulin drops, the serum group with autologous serum drops, and the honey group with honey-based drops. Culture-based medical treatment was also continued in the three groups till complete healing was achieved. The results of the three groups were compared regarding the time needed for healing and best-corrected visual acuity outcome. Results Best-corrected visual acuity improved by one or more lines in 11 (73.33%) cases in the insulin group, in 10 (66.67%) cases in the serum group, and in nine (60%) cases in the honey group, with no statistically significant difference (χ 2=1.525, P=0.822). Healing occurred in 14–28 days in 12 (80%) cases in the insulin group, in 13 (86.67%) cases in the serum group, and in 10 (66.67%) cases in the honey group, with no statistically significant difference (χ 2=1.8, P=0.407). The remaining cases in each group required amniotic membrane transplantation due to thinning. Conclusion The effects of topical insulin, autologous serum, and honey-based eye drops, when used as adjunctive methods added to the culture-based medical therapy in the management of resistant corneal ulcers, were comparable. Autologous serum gave slightly higher effect than topical insulin and honey-based eye drops but the difference was statistically insignificant.

Management of varicose ulcer by the intervention of Ta‘Līq Al-‘Alaq (leech therapy): A case study

Management of varicose ulcer by the intervention of Ta‘Līq Al-‘Alaq (leech therapy): A case study

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study.

The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation. A qualitative descriptive phenomenological study. The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method. The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales. The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.

Homoeopathic management of venous ulcer: A case study

Homoeopathic management of venous ulcer: A case study

A Case Report on Theruptor Novo: An Antimicrobial Dressing in the Management of Venous Leg Ulcer

Venous Leg Ulcer (VLU) is defined as any break in the skin that has either been present for longer than six weeks or occurs in a person with a history of VLU. VLUs are intricate and life-threatening ulcerations that result in significant expenses for health services. Compression therapy is the most preferable treatment choice for VLU. Beneath the compression devices (bandages or stockings), wound dressings are used as the primary layer to protect the wound and provide a moist environment to aid ulcer healing. Healthcare professionals face difficulty in making evidence-based decisions regarding the most appropriate treatment plan for a patient with varying needs due to the vast range of wound dressings. Hereby, the author presents a case study of a 53-year-old male patient with a non healing wound with pus discharge for 20 days over the lower limb. Skin stapler (Trupler) Novo (Healthium Medtech, India) was used as the regular primary dressing along with planned treatment. By the end of three weeks, the wound size had reduced with a low exudate level, there was no sign of infection, and there was good granulation tissue growth.

Management of non-healing post allergic ulcers with Yashtimadhu Ghrita and adjuvant Ayurvedic drugs-A Case Report

An allergic reaction arises when the immune system responds to a harmful substance. Symptoms of drug allergy can range from mild to severe and may include skin rashes, itching on hands, inner elbows, neck, feet and around the eyes, fever, swelling in the mouth and throat. In the current scenario of human health, there is a high prevalence of allergic reaction due to increasing use of unnatural sources in Food, Medicine and other substances used in routine life. In this case report a 62 year old male patient presented in Shalya Tantra outdoor patient department with complaints of multiple ulcers in bilateral leg since one year, accompanied by severe burning sensation in bilateral leg since six months. In the presentation of allergic ulcer patient had history of trauma on medial malleolus of right foot before four years and ulcer was developed at right medial malleolus. The patient also had a previous allergic reaction to debridement (debridace) ointment. This patient was managed with Vrana Prakshalan using Panchavalkala Kwatha, followed by the local application of Yashtimadhu Ghrita twice daily. Additionally, Avipattikar Churna (5g) mixed with Sootashekhar Rasa (125mg) was administered twice daily after meals with normal water for 21 days. Within 10 days of treatment, the burning sensation subsided, and bandaging with Yashtimadhu Ghrita was initiated. By the second week of treatment, signs of ulcer healing began to appear, and complete ulcer healing was achieved in six weeks. Generally inflammatory condition is seen in allergic reactions, but in this case, ulcers developed due to allergy. This single case report shows that Yashtimadhu Ghrita and adjuvant Ayurvedic medicines have properties to treat post allergic ulcer.

A Multicenter Retrospective Study Comparing a Polylactic Acid CAMP With Intact Fish Skin Graft or a Collagen Dressing in the Management of Diabetic Foot Ulcers and Venous Leg Ulcers

Background. Venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs) are examples of chronic wounds that pose an ongoing health care challenge. Despite significant progress in managing such wounds, challenges persist that require innovative solutions. Cellular, acellular, and matrix-like products (CAMPs) are advanced therapies designed to facilitate chronic wound healing. Polylactic acid (PLA) is a synthetic material used in alloplastic CAMPs that has shown promise in the management of burns and traumatic injuries. Objective. To retrospectively assess the effect of PLA in promoting chronic wound healing compared with 2 other well-established CAMPs. Materials and Methods. This retrospective chart review, which was conducted in 3 high-volume wound care clinics, aimed to compare the efficacy of 2 advanced wound care products vs a PLA alloplastic CAMP in promoting DFU and VLU closure. The study included 131 wounds treated with a non-CAMP collagen dressing, fish skin grafts (FSGs), or PLA matrices. Inclusion criteria included single Wagner grade 1 or 2 DFUs or Clinical-Etiology-Anatomy-Pathophysiology classification score C6 VLUs, present for at least 12 to 52 weeks, and measuring between 1 cm² and 20 cm². Patients received weekly treatments with 1 of 3 CAMPs, along with standard care. The primary outcome was time to achieve full healing, and the secondary outcome was the proportion of ulcers healed at 12 weeks. Results. The PLA alloplastic CAMP demonstrated superior outcomes, with a 50% and 20% reduction in time to heal DFUs compared with collagen dressings and FSG, respectively (P < .001). For VLUs, PLA exhibited even more impressive results, achieving 95% and 40% reduction compared with collagen and FSG, respectively (P < .001). PLA allografts displayed a 55% higher rate of full healing by 12 weeks compared with collagen dressings, and a 26% higher rate compared with FSG (P < .001). Conclusion. This study highlights the unique attributes of PLA for achieving wound closure. PLA-based alloplastic CAMPs are promising treatments, offering rapid healing, increased closure rates, and multifaceted benefits for wound healing.

Knowledge, Practices, and Influencing Factors of Pressure Ulcer Prevention and Management in Selected Hospitals in China

Knowledge, Practices, and Influencing Factors of Pressure Ulcer Prevention and Management in Selected Hospitals in China

Enhancing Diagnostic Accuracy with SE-Inception Model Integration in Pressure Ulcer Detection.

Pressure ulcers are a prevalent health concern, often leading to severe complications if not diagnosed and treated promptly. This study introduces the Squeeze-and-Excitation (SE)-Inception model, which integrates SE blocks into the Inception architecture, aiming to enhance classification performance in medical image analysis. The performance of the SE-Inception model was compared to the Xception and Inception v4 models. Key performance metrics such as accuracy, Area Under the Curve (AUC), recall, and Harmonic Mean of Precision and Recall (F1 score) were used to evaluate its efficacy. Gradient-weighted Class Activation Mapping (Grad-CAM) heatmaps were utilized to provide interpretable visual evidence consistent with expert annotations. The SE-Inception model demonstrated superior accuracy (93%) and AUC (94%), with high recall and F1 scores, indicating its efficacy in reducing false negatives and improving diagnostic reliability. Despite the promising outcomes, the study acknowledges the limitation of dataset homogeneity and suggests further validation with diverse datasets for enhanced scalability. The findings support the inclusion of the SE-Inception model in clinical settings to improve diagnostic precision and patient care, particularly in nursing practices for effective pressure ulcer management.

Peptic Ulcer: A review

Peptic ulcers, characterized by painful sores that develop on the lining of the stomach, small intestine, or esophagus, are a prevalent gastrointestinal condition affecting millions worldwide. This abstract provides an overview of the causes, symptoms, and treatment options for peptic ulcers. Peptic ulcers primarily stem from the imbalance between aggressive factors such as gastric acid secretion, pepsin, and Helicobacter pylori infection, and defensive mechanisms like mucosal barrier integrity and blood flow. Lifestyle factors such as excessive alcohol consumption, smoking, and stress, along with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), also contribute to ulcer formation. Symptoms of peptic ulcers include burning pain in the abdomen, bloating, nausea, vomiting, and unintended weight loss. However, some individuals may remain asymptomatic or experience atypical symptoms. Diagnosis typically involves a combination of medical history assessment, physical examination, and diagnostic tests such as endoscopy, barium X-ray, and H. pylori testing. Treatment aims to alleviate symptoms, promote ulcer healing, and prevent recurrence. Proton pump inhibitors (PPIs), histamine receptor antagonists (H2RAs), and antibiotics are commonly prescribed to reduce gastric acid secretion, eradicate H. pylori infection, and promote ulcer healing. Lifestyle modifications including dietary changes, stress reduction techniques, and cessation of smoking and alcohol consumption are also integral components of ulcer management. In conclusion, peptic ulcers are a common gastrointestinal disorder with multifactorial etiology. Early recognition of symptoms, accurate diagnosis, and prompt initiation of appropriate treatment are essential to prevent complications and improve patient outcomes.

Endoscopic vacuum therapy: pitfalls, tips and tricks, insights, and perspectives.

This article provides a comprehensive review of the use of endoscopic vacuum therapy (EVT) in the management of transmural gastrointestinal (GI) defects (TGIDs) and its future perspectives, such as pre-emptive EVT and novel indications, including GI bleeding and large gastroduodenal ulcers management. This review is based on the available literature data and personal experience to demystify the mentioned limitations of EVT as technical difficulties related to the procedure, possible patients' complaints, and institutions' concerns, by sharing several tips and tricks to overcome EVT-related challenges that may discourage endoscopists from using this live-saving technique, and consequently, restricting patients to receive this therapy, which may lead to undesired outcomes. Several factors, such as placement techniques, EVT type selection, management during its use, EVT system exchanges, device removal, type of anesthesia, and how to avoid EVT-related adverse events are described in detail. Additionally, this review discusses good ways to promote effective communication with patients and relatives, surgeons, and multidisciplinary team. EVT possesses a unique mechanism of action including macro/micro deformation, changes in perfusion (stimulating angioneogenesis), exudate control, and bacterial clearance, promoting healing. EVT has an adequate safety profile and higher clinical success rate compared to any other endoscopic therapy for TGID. Additionally, pre-emptive EVT and its novel indications are promising due to its satisfactory effectiveness in initial studies. Therefore, detailing some practical solutions obtained by years of experience may collaborate to widespread EVT adoption, providing less-invasive treatment for several critical conditions to more patients worldwide.

Practices and Challenges of Home Care Pressure Ulcer Management;Perception of Home-visit Nurses Who Have Completed the Specified Medical Acts Training.

This study aims to clarify practices and challenges on pressure ulcer management as perceived by home-visit nurses who have completed the specified medical acts training. We gathered 8 home-visit nurses who have completed the training in Japan. First-author conducted in-depth, semi-structured individual interviews, asking for their insights on home care pressure ulcer management. We found that the home-visit nurses conducted the following practices;[having understandings and empathy as a health care professional who engage with client's lives with developing/worsening pressure ulcer], [pressure ulcer care at its best within limited resources], [systematic advice and guidance to caregivers and other professionals], and [demonstration of nursing as the post-training nurse of the specified medical acts]. We also learn that the home-visit nurses were faced with following challenges:[difficulties in smoothly collaborating with multiple professionals from different organizations], [not reaching a high level of expertise or skill], [limitations under the long-term care and medical insurance systems] and [impact of COVID-19]. Home-visit nurses who have completed the specified medical acts training provided the nurses worked toward raising community's awareness of the care by providing leaderships to those involved in health care teams and collaborating with other professionals. J. Med. Invest. 71 : 346-355, August, 2024.

A COVID-19 Silver Lining-Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017-2022).

Antibiotic resistance (AR) associated with chronic limb-threatening ischemia (CLTI) poses additional challenges for the management of ischemic leg ulcers, increasing the likelihood of severe outcomes. This study assessed AR prevalence in bacteria isolated from CLTI-associated leg ulcers before (1 January 2017-10 March 2020; n = 69) and during (11 March 2020-31 December 2022; n = 59) the COVID-19 pandemic from patients admitted with positive wound cultures to a regional hospital in Chiang Mai (Thailand). There was a marked reduction in AR rates from 78% pre-pandemic to 42% during the pandemic (p < 0.0001), with rates of polymicrobial infections 22 percentage points lower (from 61% to 39%, respectively; p = 0.014). There were reduced AR rates to amoxicillin/clavulanate (from 42% to 4%; p < 0.0001) and ampicillin (from 16% to 2%; p = 0.017), as well as multidrug resistance (19% to 8%; p = 0.026). Factors associated with increased AR odds were polymicrobial infections (adjusted odds ratio (aOR) 5.6 (95% CI 2.1, 15.0); p = 0.001), gram-negative bacteria (aOR 7.0 (95% CI 2.4, 20.5); p < 0.001), and prior use of antibiotics (aOR 11.9 (95% CI 1.1, 128.2); p = 0.041). Improvements in infection control measures and hygiene practices in the community during the pandemic were likely key factors contributing to lower AR rates. Thus, strategic public health interventions, including community education on hygiene and the informed use of antibiotics, may be crucial in mitigating the challenges posed by AR in CLTI. Further, advocating for more judicious use of empirical antibiotics in clinical settings can balance effective treatment against AR development, thereby improving patient outcomes.

Algorithm for surgical treatment of gastroduodenal ulcer with multiple combined complications

Surgical management of gastroduodenal ulcers (GDU) and multiple combined complications (MCC) remains a relevant, complex and unresolved issue. There are currently no well‑defined algorithms, strategies, or surgical procedures for the treatment of gastroduodenal ulcers accompanied by a variety of complications. Objective — to improve the results of surgical treatment and reduce the mortality of patients with GDU and MCC by implementing a surgical treatment algorithm. Materials and methods. The results of surgical treatment of patients with complicated GDU for the period 2000—2022 are presented. A total of 395 (100.0%) patients with GDU accompanied by MCC (a combination of two or more complications) were operated on. There were 52 (13.16%) patients with gastric ulcer perforation and 301 (76.2%) patients with duodenal perforation. A combination of two complications was noted in 299 (75.69%) patients, three — in 88 (22.28%) patients, and four — in 8 (2.03%) patients. Results. A total of 352 (89.11%) operative interventions were performed in an emergency, 43 (10.88%) were performed in the early delayed period (EDP). The implementation of a new algorithm of surgical treatment in the main group and the use of modern measures of endoscopic hemostasis made it possible to increase the rate of operated patients in EDP by 2.6 times, and reduce the mortality rate from 10.14% to 6.45%. The highest rate of mortality is associated with gastric resection in patients with GDU and MCC — 3 (42.87%) out of 7 patients. The lowest mortality rate was among patients who underwent one of the types of organ‑saving surgery — 7 (2.86%) patients out of 245 operated on in this group. Conclusions. The implementation of the algorithm for providing surgical care to patients with GDU accompanied by MCC made it possible to reduce intraoperative mortality from 10.14% to 6.45%. The use of modern means of endoscopic hemostasis made it possible to stabilise, adequately prepare, and operate patients in EDP, which is confirmed by the increase of this indicator in the main group by 2.6 times. The highest mortality rate was in patients who underwent gastric resection and was 42.87%.

A Study of Potential Drug-Drug Interactions in Peptic Ulcer Patients in Dr. M. Djamil Hospital Padang in 2019

A peptic ulcer is a gastrointestinal tract disorder caused by excessive secretion of acid and pepsin by the gastric mucosa. The combined use of drugs in peptic ulcer management may potentially cause drug-to-drug interactions. Drug interactions are caused when two or more drugs interact and may affect the effectiveness of the other drugs. This study aims to analyze the potential drug reactions in peptic ulcer patients in the internal medicine ward of Dr. M. Djamil General Hospital Padang in 2019. This study was a descriptive, non-experimental study with retrospective data, while data analysis used Drugs.com and Medscape applications. The study results revealed that 29 patients fit the inclusion criteria and 5 (16.6%) potential drug pharmacokinetic interactions. The severity of drug interactions shows 4 cases (80%) with moderate severity potential and 1 case (20%) with minor severity potential. The study concluded that there were potential drug interactions in peptic ulcer patients in the internal medicine ward of Dr. M. Djamil General Hospital Padang in 2019.

In vivo strain measurements in the human buttock during sitting using MR-based digital volume correlation

Advancements in systems for prevention and management of pressure ulcers require a more detailed understanding of the complex response of soft tissues to compressive loads. This study aimed at quantifying the progressive deformation of the buttock based on 3D measurements of soft tissue displacements from MR scans of 10 healthy subjects in a semi-recumbent position. Measurements were obtained using digital volume correlation (DVC) and released as a public dataset. A first parametric optimisation of the global registration step aimed at aligning skeletal elements showed acceptable values of Dice coefficient (around 80%). A second parametric optimisation on the deformable registration method showed errors of 0.99mm and 1.78mm against two simulated fields with magnitude 7.30±3.15mm and 19.37±9.58mm, respectively, generated with a finite element model of the buttock under sitting loads. Measurements allowed the quantification of the slide of the gluteus maximus away from the ischial tuberosity (IT, average 13.74 mm) that was only qualitatively identified in the literature, highlighting the importance of the ischial bursa in allowing sliding. Spatial evolution of the maximus shear strain on a path from the IT to the seating interface showed a peak of compression in the fat, close to the interface with the muscle. Obtained peak values were above the proposed damage threshold in the literature. Results in the study showed the complexity of the deformation of the soft tissues in the buttock and the need for further investigations aimed at isolating factors such as tissue geometry, duration and extent of load, sitting posture and tissue properties.

Theruptor Novo, a novel wound dressing in the management of infected diabetic foot ulcer: two case reports

India is the world's center for diabetes, with an estimated 77 million adults over the age of 18 having type 2 diabetes and nearly 25 million are pre-diabetics. Approximately 15-20% of diabetic patients will suffer from diabetic foot ulcer at least once in their lifetime which can also lead to deformity and amputation if timely intervention is not done. The presence of at least two classic signs of inflammation or purulence is the basis of clinical diagnosis of diabetic foot infection and it usually presents with mono/polymicrobial etiology. The surgeon must know the course of the infection, principles of non-healing wound management, and biomechanics of the foot for an optimal outcome. We described 2 case reports who presented with non-healing infected wounds. Healing was achieved through multidisciplinary team approach, patient education about diabetes, off-loading regime and regular wound dressing using Theruptor Novo.

Venous leg ulcers: a literature review

The purpose of the literature review is to give the reader a general understanding of Venous Leg Ulcers. Understanding the history, pathophysiology, presentation, and treatment of venous leg ulcers is important in the approach and management of venous leg ulcers. Venous leg ulcers have existed since the 1200’s and it is found that early intervention with combined treatments is more efficient in treating venous leg ulcers while also lowering the recurrence rate of the venous leg ulcers

Drug Utilization Research and Predictors of Outcomes in the Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study.

Multiple drugs are commonly prescribed to intensive care unit (ICU) patients owing to the disease profile, multiple organ dysfunction, prophylaxis, management of stress ulcers, nosocomial infections, etc. This study aimed to evaluate the drug utilization patterns and factors influencing mortality and duration of stay in ICU patients. Methodology: A prospective observational study was conducted in the ICUof our tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak. Data was collected from treatment charts of patients using a structured pretested proforma. World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose (WHO ATC/DDD) methodology and core prescribing indicators were used to assess drug utilization data. The effect of different variables on mortality and duration of stay in the ICU was evaluated using regression analysis. An average of 8.78 drugs were prescribed per patient. Among the 922 prescriptions, anti-infectives, anti-inflammatory drugs, and drugs acting on the gastrointestinal tract were the most frequent medication classes prescribed. Polypharmacy and trade name prescribing were common. For most of the drugs, the prescribed daily dose corresponded to the WHO-DDD except ceftriaxone and levofloxacin. Age, presence of cardiac disorders, and Glasgow Coma Scale (GCS) score at admission directly correlated with mortality while the use of diuretics had a negative correlation with the duration of ICU stay. Conclusions: There is a need to rationalize drug therapy in the ICUwith regard to limiting polypharmacyand emphasizing generic drug name prescribing and adherence to the essential drug list. Antibiotic prescription patterns, in particular, deserve a special focus keeping in mind the multitude of factors demanding aggressive antibiotic use in critically ill intensive care patients.

Management of major recurrent aphthous ulcers with 5% amlexanox oral paste and rebamipide tablets- A case report with a brief literature review

Recurrent aphthous stomatitis (RAS) is a common chronic inflammatory oral mucosal disorder marked by the presence of painful, recurring ulcers, occurring either as solitary lesions or in multiple clusters. While the clinical features of this condition are easily recognizable, the precise etiology remains obscure. The disorder manifests in three forms, of which minor RAS are the commonest and heal within 10-14 days. Major RAS presents as larger, painful chronic ulcerations and heals with scarring in 6-8 weeks. A comprehensive medical history and a thorough systemic examination can aid the physician in determining whether the condition is idiopathic or linked to a underlying systemic disorder. The management of oral aphthous ulcers poses a significant challenge and there is no established and defined therapeutic regimen available for RAS. We present a case of major RAS in a 37-year-old patient who was unresponsive to topical and systemic steroid therapy. 5% Amlexenox paste and rebamipide tablets were used in the present case. The patient showed favourable healing within a week therapy with no recurrences during the 6-month follow up.