Ulcer Prevention Research Articles

Comparison of customized vacuum sealing drainage and vacuum sealing drainage in the treatment of diabetic foot ulcers: a retrospective analysis

BackgroundThe prevalence of diabetic foot ulcers, a common, more serious chronic diabetes-related complication, is increasing. Vacuum sealing drainage (VSD) constitutes an effective adjunctive treatment for diabetic foot ulcers. Factors, such as poor glycemic control, ischemia, and infection prolong wound healing time, and VSD products are expensive and unaffordable for many patients.ObjectiveTo compare the use of customized VSD and customized VSD in the treatment of diabetic foot ulcer.MethodThis retrospective study included 83 patients with diabetic foot ulcers in customized VSD (n = 44) and VSD (n = 39) groups. Baseline data, efficacy after 14 days, total treatment efficiency, final outcome (28 days after treatment, healing rate), average treatment cost, and hospitalization (days) of the two groups were compared. Factors affecting wound healing were analyzed.ResultsNo significant intergroup differences in the baseline data were detected (VSD vs. customized VAD, p > 0.05). Treatment efficacy was higher in the customized VSD group than in the VSD group after 14 days (p < 0.05), although total treatment efficiency in both groups reached 100%. The final outcome in the customized VSD group was better (vs. VSD group, p < 0.05), and the wound healing rate was higher than in the VSD group (66.7% vs. 33.3%). The mean treatment cost and hospital days were greater in the VSD group (vs. customized VSD group; p < 0.05). Factors affecting wound healing include age, Wagner classification, HDL-C, and fasting C-peptide. Younger age, low Wagner classification grade, low HDL-C level, and high fasting C-peptide contribute to higher healing rate,ConclusionEfficacy and final outcome of customized VSD were better than that of VSD; the customized VSD device is simple and convenient to operate, and enables cost-effective treatment.

Prevalence of Pressure Ulcer in Orthopaedic Bedridden Patients With a Higher Braden Pressure Ulcer Score in a Tertiary Care Government Hospital in Jammu

In this research, our primary objective was to determine the prevalence of pressure ulcers (PU) in bedridden patients with risk of higher Braden Pressure Ulcer scores who were admitted to the orthopaedic wards at the tertiary care government hospital in Jammu. Methodology To achieve this, we conducted a cross-sectional point prevalence study utilising the Braden Pressure Ulcer Risk Assessment Scale and the European Pressure Ulcer Advisory Panel (EPUAP) grading scale and data form. Our research sample consisted of 180 bedridden patients with higher Braden scores admitted to the orthopaedic ward of the selected facility. We monitored these patients using an observational checklist based on the established EPUAP minimal dataset form and grading scale. We conveniently selected patients who had moderate to severe Braden Pressure Ulcer Risk scores. Result Our findings revealed that 22.8% of the bedridden patients with moderate to high-risk Braden pressure ulcer scores developed pressure ulcers. Among the respondents, the majority (67.78%) were categorised as high risk, followed by severe risk (18.89%) and moderate risk (13.33%). Of those who developed pressure ulcers, 28 had Grade 1 ulcers and 12 had Grade 2 ulcers. The most common locations for these ulcers were the sacrum (40%), followed by the iliac region (35%), and the buttocks (25%). We did not observe any significant association between clinical variables and the incidence of pressure ulcers, except for skin turgor.

Retrospective study of occurrence of pressure ulcers among the patients admitted in rural tertiary care hospital and their outcome

This retrospective study addresses the pivotal role of pressure ulcer prevention in evaluating the quality of care within critical care units. The incidence of pressure ulcers serves as a crucial indicator, impacting patient recovery and complicating treatment. In this data based retrospective study we assessed the prevalence of pressure ulcers for a duration of 6 years. In this data we included the patients from surgical, medical, respiratory and cardiac critical care units who were admitted between 01/06/16 to 01/06/22. All male and female patients aged above 18 years were included. Patients who got discharge within 48 hours were excluded. Total of 35 patients were noted to have bedsores in intensive care unit from June 2016-June 2022 admitted under both medical and surgical branches. Out of which 34.3% were in age group above 70yrs where 87.9% were male patients. Most commonly 1-2 bedsores (97.1%) were present involving mostly buttock area (82.9%) of 2-5cm size (45.7%). Most of the patients admitted under medical branch developed bedsores more often than surgical branch and appeared after admission (77.1%) with 15-30 days hospital stay (31.4%). This study has illuminated our path forward in improving patient care and preventing pressure ulcer development among patients admitted to our medical and surgical Intensive Care Units in our Rural Tertiary hospital. The findings have paved the way for targeted interventions, underlining our commitment to raising the standard of care for our critically ill patients.

Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes.

Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).

PREVALENCE AND ASSOCIATED FACTORS OF PEPTIC ULCER DISEASE AMONG DYSPEPTIC PATIENTS AT ENDOSCOPY UNIT IN KABUL, AFGHANISTAN

Introduction: Dyspepsia is a medical term utilized to describe a cluster of symptoms related to the digestive system, particularly in the upper gastrointestinal tract. The most prevalent causes of dyspepsia encompass gastro esophageal reflux disease (GERD), peptic ulcer disease (PUD), and non-ulcer dyspepsia (NUD). A peptic ulcer is a sore or erosion that forms in the lining of the stomach, upper part of the small intestine, or lower part esophagus.&#x0D; Materials and Methods: The study incorporated 500 dyspeptic patients who underwent upper gastrointestinal endoscopic assessments. This hospital-based analytical cross-sectional study was conducted at the endoscopy unit of different hospitals, spanning from January 1, 2023, to September 30, 2023.&#x0D; Results: The findings revealed that out of 500 dyspeptic patients, 45 (9%) exhibited positive results for peptic ulcer, while 455 (91%) displayed non-peptic ulcer conditions. The correlation between dyspepsia and peptic ulcer was statistically significant (χ2= 73, P= 0.01). Gender-specific prevalence indicated that 17 (37.7%) males and 28 (62.2%) females exhibited peptic ulcers. When stratified by age, the prevalence was 20 (44.4%) for individuals aged 18-40, 10 (22.2%) for those aged 41-52, and 15 (33.3%) for those above 52 years. Notably, significant differences were observed among age groups (χ2= 85, P= 0.04). Peptic ulcer prevalence was 16 (35.55%) for urban residents and 29 (64.44%) for rural residents. In the context of smoking habits, 30 (66.6%) of smokers exhibited peptic ulcers, compared to 15 (33.3%) of non-smokers. The association between smoking and peptic ulcers was statistically significant (χ2= 101, P= 0.02). Additionally, 28 (62.2%) of individuals with H. pylori infections displayed peptic ulcers, in contrast to 17(37.7%) without the infection. The association between H. pylori infection and peptic ulcers was statistically significant (χ2= 85, P= 0.05). Regarding NSAID use, 29 (64.4%) of participants who used NSAIDs and 16 (35.5%) who did not use NSAIDs showed peptic ulcer prevalence. The highest prevalence was among individuals using NSAIDs for pain relief. The association between NSAID use and peptic ulcers was statistically significant (χ2= 100, P= 0.05).&#x0D; Discussion: These results highlight the significance of addressing these risk factors in the management and prevention of peptic ulcer disease.

HLA-DR genotypes in patients with systemic lupus erythematosus in Taiwan.

Different human leukocyte antigen (HLA)-DR genotypes have been known to be associated with the risk of development of systemic lupus erythematosus (SLE) in different populations, although Lu et al. have reported previously that no correlation exists between the HLA-DR genotype and disease manifestation in SLE patients in Taiwan. We investigated the effects different HLA-DR genotypes had on SLE incidence in Taiwanese patients as to whether risk alleles were associated with different clinical manifestations, and the effects risk alleles had on the age of disease onset. Two hundred thirty-four SLE patients and 346 healthy controls were enrolled. HLA-DR genotyping was performed with the HLA FluoGene DRDQ kit for each subject. Chi-square tests and t tests were performed for statistical analysis. HLA-DR2 was significantly more frequently found in SLE patients than in controls (odds ratio [OR] = 2.05, 95% CI, 1.44-2.92, p < 0.001). Notably, HLA-DR6 appeared to trend toward negative correlation with SLE, whereas HLA-DR8 appeared to trend toward positive correlation. HLA-DR2 patients had an earlier onset of disease as well as a higher prevalence of oral ulcer, avascular necrosis of bone, and renal involvement (lupus nephritis). HLA-DR2 was associated with SLE susceptibility in this Taiwanese population as well as lower age of disease onset and more severe clinical manifestations.

Compression therapy for NHS inpatients with leg ulcers: a literature review.

Leg ulcers are common, distressing and painful for patients, and are a significant financial burden to healthcare providers. Compression therapy is the mainstay of treatment for venous leg ulceration. Several studies have evaluated leg ulcer management and compression therapy in the community. However, little is known about the prevalence of leg ulceration and use of compression therapy in acute hospitals. The aim of this study was to explore the published literature on the use of compression therapy for inpatients with leg ulcers in UK National Health Service hospital settings. A literature search was undertaken to identify published papers reporting on inpatient leg ulcer populations and the use of compression therapy in hospitals using the following databases: CINAHL, MEDLINE Complete, Embase and PubMed. The literature review identified 364 articles, of which three met the eligibility criteria. These studies reported on the prevalence of leg ulceration, the number of Doppler assessments conducted for patients and the use of compression therapy. This review confirmed a lack of information on the prevalence of hospital inpatients with leg ulcers, and identified the need to conduct prevalence audits, establish leg ulcer services to streamline inpatient leg ulcer care and provide staff and patient education programmes.

A review of the long-term use of proton pump inhibitors and risk of celiac disease in the context of HLA-DQ2 and HLA-DQ8 genetic predisposition.

Proton pump inhibitors (PPIs) are among the most prescribed and widely used medications; however, the long-term effects of these medications are only beginning to be investigated. Since the introduction of omeprazole in 1989, PPIs have become the first-choice treatment for esophagitis, peptic ulcer disease, Zoster-Ellison syndrome, dyspepsia, and the prevention of ulcers with non-steroidal anti-inflammatory drugs. Recent studies have specifically examined the rise in celiac disease (CD) in this context. This review explores how PPIs may impact the development of CD and highlights the need for additional research into the environmental and genetic factors that influence the development and progression of the disease. A literature search was performed using the keywords celiac disease, proton pump inhibitors, human leukocyte antigen (HLA)-DQ2, HLA-DQ8. The pathogenesis of CD is multifactorial, and human leukocyte antigens are one factor that may contribute to its development. Additionally, pharmaceuticals, such as PPIs, that cause gut dysbiosis have been linked to the inflammatory response present in CD. Recent studies have suggested that the rise in CD could be attributed to changes in the gut microbiome, highlighting the significant role that gut microbiota is proposed to play in CD pathogenesis. Although PPI therapy is helpful in reducing acid production in gastroesophageal disorders, additional information is needed to determine whether PPIs are still an appropriate treatment option with the possibility of developing CD in the future, particularly in the context of HLA-DQ2 and HLA-DQ8 predispositions. This review emphasizes the importance of personalized medicine for individuals with gastroesophageal disorders that require long-term use of PPIs.

The awareness and determinants of diabetic foot ulcer prevention among diabetic patients: Insights from NHANES (2011–2018)

The prevention of diabetic foot ulcers (DFU) precedes treatment, in that early prevention significantly reduces the incidence of foot ulcers. The main objectives of this study were to examine the current prevalence of proactive foot ulcer examinations among diabetic patients and analyze influencing factors, in order to provide a scientific reference for the prevention of DFU in diabetic patients. The National Health and Nutrition Examination Survey (NHANES) 2011–2018 (n = 1278) data were utilized in this cross-sectional study. The dependent variable was whether patients underwent self-initiated foot ulcer inspections; risk factors that may lead to foot ulcers were included as independent variables. To explore the connection between the patient’s subjective motivation to inspect foot ulcers and risk variables, the weighted logistic regression model was further carried out. Among all risk factors, race, body mass index (BMI) and hypertension were statistically significant between whether patients were examined for foot ulcers or not. In the fully adjusted logistic regression model, only hypertension was positively correlated with diabetic patient-initiated examination for foot ulcers. This study suggests that there is still room for improvement in the knowledge and behavior of diabetic patients to be proactive in preventing DFU. Health care and community workers should conduct targeted training on diabetic foot prevention to reduce and prevent DFU by reinforcing knowledge to build positive attitudes and drive preventive behavior change.

FEET: First Nations Empowerment Through Enabling Technology: An Indigenous-led Health Pilot For Diabetic Foot Ulcer Prevention

Diabetes is a significant health challenge for Indigenous populations in Canada. Diabetic foot ulcers are common. Siksika Nation, a First Nation in Alberta, Canada provides healthcare to nearly 8,000 members through Siksika Health Services (SHS). This presentation highlights a 24-week pilot focusing on the prevention and early detection of diabetic foot ulcers and on promoting foot health within the Nation.

Factors influencing re-bleeding after trans-arterial embolization for endoscopically unmanageable peptic ulcer bleeding

Background/Aims Acute peptic ulcer bleeding is the most common cause of non-variceal upper gastrointestinal bleeding (NVUGIB). Endoscopic hemostasis is the standard treatment. However, various conditions complicate endoscopic hemostasis. Transarterial visceral embolization (TAE) may be helpful as a rescue therapy. This study aimed to investigate the factors associated with rebleeding after TAE. Methods We retrospectively investigated the records of 156 patients treated with TAE between January 2007 and December 2021. Rebleeding was defined as the presence of melena, hematemesis, or hematochezia, with a fall (>2.0 g/dl) in hemoglobin level or shock after TAE. The primary outcomes were rebleeding rate and 30-day mortality. Results Seventy patients with peptic ulcer bleeding were selected, and rebleeding within a month after TAE occurred in 15 patients (21.4%). Among the patients included in rebleeding group, significant increases were observed in the prevalence of thrombocytopenia (73.3% vs. 16.4%, p<.001) and ulcers >1 cm (93.3% vs 54.5%, p = .014). The mean AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age >65 years) score (2.3 vs 1.4, p = .009) was significantly higher in the rebleeding group. Multivariate logistic analysis revealed that thrombocytopenia (odds ratio 31.92, 95% confidence interval 6.24–270.6, p<.001) and larger ulcer size (odds ratio 27.19, 95% confidence interval 3.27–677.7, p=.010) significantly increased the risk of rebleeding after TAE. Conclusion TAE was effective in the treatment of patients with high-risk peptic ulcer bleeding. AIMS65 score was a significant predictor of rebleeding after TAE, and thrombocytopenia and larger ulcer size increased the risk of rebleeding after TAE.

Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: a systematic review and meta-analysis

The number of diabetic foot ulcer patients is substantially increasing, with the rapidly rising burden of diabetic mellitus in sub-Saharan Africa. The data on the regional prevalence of diabetic foot ulcer infecting bacteria and their antimicrobial resistance patterns is crucial for its proper management. This systematic review and meta-analysis determined the pooled prevalence of bacterial profiles and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa. A comprehensive search of the literature was performed on CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Critical appraisal was done using the Joanna Briggs Institute’s tool for prevalence studies. A pooled statistical meta-analysis was conducted using STATA Version 17.0. The I2 statistics and Egger’s test were used to assess the heterogeneity and publication bias. The pooled prevalence and the corresponding 95% confidence interval of bacterial profiles and their antimicrobial resistance patterns were estimated using a random effect model. Eleven studies with a total of 1174 study participants and 1701 bacteria isolates were included. The pooled prevalence of the most common bacterial isolates obtained from DFU were S. aureus (34.34%), E. coli (21.16%), and P. aeruginosa (20.98%). The highest pooled resistance pattern of S. aureus was towards Gentamicin (57.96%) and Ciprofloxacin (52.45%). E.coli and K. Pneumoniae showed more than a 50% resistance rate for the most common antibiotics tested. Both gram-positive and gram-negative bacteria were associated with diabetic foot ulcers in sub-Saharan Africa. Our findings are important for planning treatment with the appropriate antibiotics in the region. The high antimicrobial resistance prevalence rate indicates the need for context-specific effective strategies aimed at infection prevention and evidence-based alternative therapies.

Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention.

To investigate reliability and changes of in-shoe plantar pressure and shear during walking at three cadences with two insole designs. This was a precursor to the investigation of plantar loading in people with diabetes for potential foot ulcer prevention. A sensorised insole system, capable of measuring plantar pressure and shear at the heel, fifth metatarsal head (5MH), first metatarsal head (1MH) and hallux, was tested with ten healthy participants during level walking. Reliability was evaluated, using intra-class correlation coefficient (ICC), while varying the cadences and insole types. Percentage changes in pressure and shear relative to values obtained at self-selected cadence with a flat insole design were investigated. Mean±standard deviation of maximum pressure, medial-lateral and anterior-posterior shear of up to 380±24kPa, 46±2kPa and -71±4kPa, respectively, were measured. The ICC in ranges of 0.762-0.973, 0.758-0.987 and 0.800-0.980 were obtained for pressure, anterior-posterior and medial-lateral shear, respectively. Opposite anterior-posterior shear directions between 5MH and 1MH (stretching), and between 1MH and hallux (pinching) were observed for some participants. Increasing cadence increased pressure and anterior-posterior shear (by up to +77%) but reduced medial-lateral shear at the heel and hallux (by up to -34%). Slower cadence increased anterior-posterior shear (+114%) but decreased medial-lateral shear (-46%) at the hallux. The use of a flexible contoured insole resulted in pressure reduction at the heel and 5MH but an increase in anterior-posterior shear at the heel (+69%) and hallux (+75%). The insole system demonstrated good reliability and is comparable to reported pressure-only systems. Pressure measurements were sensitive to changes in cadence and insole designs in ways that were consistent with the literature. However, our plantar shear showed localised shear changes with cadences and insoles for the first time, as well as stretching and pinching effects on plantar tissue. This opens new possibilities to investigate plantar tissue viability, loading characteristics and orthotic designs aimed towards foot ulcer prevention.

Enhancing Self-Management Skills of Patients With Existing Diabetic Foot Ulcerations: A Quality Improvement Project.

The purpose of this quality improvement initiative was to determine the impact of a nurse-administered foot care intervention bundle (NA-FCIB) upon self-management knowledge, skills, and outcomes in patients with diabetic foot ulcerations. The sample comprised 39 patients being treated for diabetic foot ulceration at a wound care clinic in a tertiary care hospital in Arlington, Virginia. The project was conducted from August 2017 to February 2018. This quality improvement project used the Johns Hopkins Plan-Do-Study-Act Method supplemented by self-regulation theory for diabetic patient education and evidence in clinical literature. The 12-week-long intervention included one-on-one teaching in the prevention of ulcerations and optimal care of the diabetic foot, blood glucose level tracking logs, patient "teach-back" and skills demonstration, and free foot care tools. From baseline to post-NA-FCIB, the number of participants knowing the reasons for temperature foot protection increased by 92%, those knowing major factors leading to diabetic foot ulceration by 85%, those knowing what to look for in the foot self-exam by 85%, and those able to demonstrate correct foot self-exam by 84%. The number of participants understanding proper footwear increased by 74%, and those identifying ways to avoid/decrease the likelihood of diabetic foot ulcers by 72%. Mean serum hemoglobin A1c (HgbA1c) levels decreased from baseline to postintervention (8.27%; SD 2.05% vs 7.46%; SD 1.58%; P = .002). The NA-FCIB intervention was successfully incorporated into routine clinic care as the standard of care. Our experience suggests that the NA-FCIB may be feasible and effective for use at comparable wound care clinics and may have secondary benefits for HgbA1c regulation.

Early detection of diabetic peripheral neuropathy using EMLA-induced skin wrinkling

Background &amp; Objective: Screening for early diabetic peripheral neuropathy (DN) is essential for foot ulcer prevention. The Semmes–Weinstein monofilament (SWMF) is commonly used to detect DN in Thailand. However, SWMF interpretation requires patient participation, which is susceptible to risk of error in patients with impaired cognitive function or uncooperative patients. In contrast, stimulated skin wrinkling (SSW) can be interpreted by trained investigators, which is more appropriate. This study aimed to investigate the utility of SSW using a eutectic mixture of local anesthetic (SSW-EMLA) for early DN diagnosis. Methods: This cross-sectional study, recruited 102 patients with diabetes (DM group), 33 with diabetes with foot ulcer (DN control group), and 30 without diabetes (non-DN control group) from the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Thailand, from February 3, 2021 to November 30, 2021. SSW was conducted by applying EMLA on the tips of the 2nd, 3rd, and 4th fingers of both hands. SWMF, sensory perception of pain (SPP), vibration perception threshold (VPT), joint position sense (JPS), and deep tendon reflexes (DTR) were also evaluated on the same day. Results: The Interrater agreement of two investigators for SSW-EMLA was high with intraclass correlation coefficients of 0.87 (0.824–0.904) for the right hand and 0.874 (0.830–0.907) for the left hand. The kappa coefficients of agreement of SSW-EMLA for SPP, SWMF, VPT, JPS, and DTR testing were 0.411, 0.478, 0.714, 0.444, and 0.681, respectively. The sensitivity and specificity of SSW-EMLA testing for DN detection were 83.3%, was 85.7%, respectively. Conclusion: The SSW-EMLA test can be considered as an alternative method for DN detection, due to its noninvasiveness, inexpensiveness (50THB), being a simple procedure, high sensitivity and specificity, and acceptable rater variation.

Prevalence of Diabetic Foot Ulcers among People with Diabetes Mellitus

Introduction: With 8.6% prevalence, India tops the list in terms of the burden of diabetes. A major complication of diabetes mellitus is diabetic foot ulcer, which affects type 2 diabetes more frequently. This study's objective was to determine the prevalence and risk variables that contribute to the development of diabetic foot ulcers. Method: A hospital-based cross-sectional survey was conducted with 108 type 2 diabetic patients who were chosen from the outpatient department of a major diabetic care facility. The socio-demographic data was gathered. The clinical biochemistry lab attached to the hospital performed the measurements of biochemical variables. The Wagner Meggitt Classification was used to stage each patient's diabetic foot. Results: Prevalence of Diabetic Foot Ulcer was 10.2%. Grade III was the most prevalent stage of presentation, followed by Grade IV according to classification system by Wagner Meggitt. No significant correlation between the DFU group and other metabolic parameters such hypertension, retinopathy, neuropathy, HbA1c, cholesterol, HDL, and LDL were discovered. Conclusions: There were 10.2% of diabetic individuals presented with foot ulcers. Diabetes related foot ulcers were more common in males with an average age of 56.08± 0.69 years.

Influence of Microplastics on Morphological Manifestations of Experimental Acute Colitis.

Microplastic pollution poses a threat to human health. It is possible that the increase in the incidence of inflammatory bowel disease is associated with exposure to microplastics. We investigated the effect of the consumption of polystyrene microparticles with a diameter of 5 μm at a dose of 2.3 mg/kg/day for 6 weeks on morphological changes in the colons of healthy male C57BL/6 mice and of mice with acute colitis induced by a 1% dextran sulfate sodium solution (DSS). In healthy mice, microplastics caused an increase in the number of endocrine cells, an increase in the content of highly sulfated mucins in goblet cells, an increase in the number of cells in the lamina propria, and a decrease in the volume fraction of macrophages. Microplastic consumption caused more severe acute colitis, which is characterized by a greater prevalence of ulcers and inflammation and a decrease in the content of neutral mucins in goblet cells.

Gingival health status in relation to salivary irisin in oral ulcerative patients of Diyala city, Iraq

Background: Gingivitis is the inflammation of the gingival tissue around the teeth initiated by bacteria. Irisin is a newly identified novel anti-inflammatory effect of adipocytokine. Recurrent aphthous ulcer (RAU) remains the most common ulcerative disease in the mucosa tissue of the oral cavity, existing as repeated onset of single or multiple painful ulcers. The study aims to evaluate gingival health status in relation to salivary irisin in oral ulcerative patients of Diyala City/ Iraq. The total sample consists of 200 patients taken from the specialized dental center in Ba'aquba / Diyala governorate from January-March 2022 for both genders within the 20- 31 age group. One hundred patients complaining of recurrent aphthous ulcers without systemic diseases were selected, and 100 patients were free from recurrent aphthous ulcers. The gingival inflammation was examined and recorded using Loe and Silness (1964). According to WHO (1997), a recurrent aphthous ulcer was assessed, and salivary irisin levels were determined using enzyme-linked immunosorbent assay (ELISA). In the study and control groups, the prevalence of gingivitis was 100%, with a higher mean value of GI among the study group than the control group. Minor ulcer prevalence was higher than a significant ulcer. The level of irisin was higher in the study group than in the control group, and the correlation between GI and irisin was negatively weak in the study and positively weak in the control group. Keywords: Gingival health, Irisin, RAU.

Gastroscopic characterisation and prevalence of gastric ulcer syndrome in working mules in Colombia.

The existing literature does not contain information about the prevalence of gastric ulcers in mules, and on the potential associations between the presence of ulcers and work load, work type, diet, sex, age and body condition score (BCS). To estimate the prevalence and factors associated with mule gastric ulcer syndrome (MGUS) and evaluate its distribution in both mule squamous gastric disease (MSGD) and mule glandular gastric disease (MGGD) mucosa in a population of mules in Colombia. Observational, cross-sectional. A total of 97 clinically healthy mules of different ages and locations in the province of Antioquia (Colombia) were included in this study. The mules were involved in agricultural activities (i.e., riding, pack and ranch mules) at the time of the study. The animals underwent gastroscopic evaluation, and ulcer scores from 0 to 4 were assigned based on severity, with scores ≥2 indicating clinical relevance. The presence or absence of ulcer in the squamous and/or glandular region of the stomach was recorded. Data related to work type, work load and diet, as well as sex, age and BCS were recorded for each mule. Pearson's chi-square test was used to determine the association between the outcomes and explanatory variables of the study (p ≤ 0.05). The results of the risk estimations were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The frequency of MGUS in the study population was 42%. Most of the lesions were located in the squamous region of the stomach (27%), mainly in the margo plicatus, and 20% were located in the glandular region, mainly in the fundus and pyloric antrum. Six animals showed lesions in both squamous and glandular regions. Work load was the only variable associated with the presence of MGUS (OR: 1.98; 95% CI: 0.49-0.96) and MSGD (OR: 1.78; 95% CI: 0.36-0.67). Nevertheless, the findings did not provide any significant risk assessment result, nor did they reveal any significant interactions among the other variables. This study used convenience sampling from a limited geographic region, and multivariate analysis was not performed, one of the exclusion criteria was the use of nonsteroidal anti-inflammatory drugs, which means that the effect of these drugs can no longer be evaluated. MGUS occurs in mules subjected to agricultural work, the risk factors associated with EGUS do not appear to be significant in mules and other equids subjected to the same conditions, in this region. Further research is needed to define the differential dynamics of MGUS in comparison with the findings in horses.

Definition and evaluation of a finite element model of the human heel for diabetic foot ulcer prevention under shearing loads.

Diabetic foot ulcers are triggered by mechanical loadings applied to the surface of the plantar skin. Strain is considered to play a crucial role in relation to ulcer etiology and can be assessed by Finite Element (FE) modeling. A difficulty in the generation of these models is the choice of the soft tissue material properties. In the literature, many studies attempt to model the behavior of the heel soft tissues by implementing constitutive laws that can differ significantly in terms of mechanical response. Moreover, current FE models lack of proper evaluation techniques that could estimate their ability to simulate realistic strains. In this article, we propose and evaluate a FE model of the human heel for diabetic foot ulcer prevention. Soft tissue constitutive laws are defined through the fitting of experimental stretch-stress curves published in the literature. The model is then evaluated through Digital Volume Correlation (DVC) based on non-rigid 3D Magnetic Resonance Image Registration. The results from FE analysis and DVC show similar strain locations in the fat pad and strain intensities according to the type of applied loads. For additional comparisons, different sets of constitutive models published in the literature are applied into the proposed FE mesh and simulated with the same boundary conditions. In this case, the results in terms of strains show great diversity in locations and intensities, suggesting that more research should be developed to gain insight into the mechanical properties of these tissues.