Ulcer Prevention Research Articles

New Dimensions of Staffing Patterns in Nursing Homes and Nursing Home Quality: Comparing Staffing Instability to Staffing Turnover.

This study examines how measures of staffing-turnover and instability-are associated with one another and how they independently contribute to quality of care in nursing homes. Cross-sectional analysis of 2021-2022 administrative data. Data included the Payroll Based Journal for daily staffing information, merged with Nursing Home Care Compare (NHCC) data for nursing home characteristics, total staffing turnover, and nursing home quality. A total of 11,840 nursing homes nationally reporting data on daily staffing and staffing turnover. We explored correlations between measures of staffing and estimated facility-level regression models with robust standard errors. The dependent variables were indicators of nursing home quality included in the NHCC 5-star ratings. The independent variables of interest were average total staffing hours per resident-day, total staffing turnover, and total staffing instability. For the 11,840 nursing homes in the study, there was a weak positive correlation between turnover and instability, with some overlap between nursing homes with high instability and high turnover. Regression analysis revealed that staffing instability and turnover contributed independently to nursing home quality, with instability having a stronger association with some measures of quality and turnover with others. Staffing instability was positively and more strongly associated with long-stay residents' decline in activities of daily living levels and receipt of antipsychotic drugs and short-stay residents' functioning at discharge. Turnover was positively and more strongly associated with long-stay residents' prevalence of pressure ulcers and worsening mobility, and short-stay residents' hospitalizations. Instability and turnover in total nursing home staffing independently contribute to nursing home quality. This suggests that adding measures of staffing instability to the existing measures of average staffing and staff turnover in NHCC may enhance the report card's value for providers engaged in quality improvement and consumers searching for high-quality nursing homes.

Dermoscopic Pattern of Basal Cell Carcinoma in H- and Non-H-zones.

Basal cell carcinoma (BCC) localized in the H-zone, the region of fusion of embryonic masses, has been associated with a higher risk of deeper invasion and more frequent recurrence. The aim of the study was to compare dermoscopic features of BCC in H and non-H zone that may most appropriately characterize those two locations. Dermoscopy images of histopathologically confirmed BCCs from 120 patients were retro-spectively analyzed. Dermoscopy features of BCC in H- and non-H zone were described and a comparative study of the dermoscopic pattern of BCC between the two locations was performed. Of 120 BCC cases included in this study, 41 (34.2%) were located in the H-zone. The most frequent histological type was nodular (51.3% in H- zone and 61.6 % in non-H-zone) followed by superficial (5.1% and 19.8 % in H and non-H-zone respectively).In dermoscopy, there was a higher prevalence of ulceration (73.2% versus 43.6%, P < 0.001) in H-zone and a lower prevalence of brown globules (26.8% versus 53.2%; P = 0.01), when compared with the non-H-zone. Our results show that dermoscopic features of BCC on the face fulfill a typical pattern regardless of the region, except for the prevalence of the ulceration which is significantly more frequent in H-zone and the brown globules present significantly more often in the non-H-zone It can be hypothesized that H-zone might predispose to more aggressive course of BCC complicated by ulceration and consequently deeper tissue destruction.

Prevalence of diabetes foot ulcers and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia.

Diabetes mellitus (DM) causes significant morbidity and mortality in sub-Saharan Africa (SSA), including Somalia. Among diabetic patients, diabetic foot ulcers (DFUs) constitute the largest proportion of admissions, amputations, and mortality. The aim of this study is to assess the prevalence of diabetic foot ulcers and subsequently determine factors associated with it among diabetic patients at three major hospitals in Somalia. An institutional-based cross-sectional study was conducted among 193 diabetic patients between August and November 2022. All eligible diabetes patients who were attending De Martini Hospital, Madina General Hospital, and Deynile General Hospital during the study period were included in the study. Patients were interviewed using a structured questionnaire. We collected demographic, clinical, and behavioral variables from all participants. A bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. An odds ratio with a 95% confidence interval was computed to determine the level of significance. The mean age of the study's participants was 50.9 ± 13.6 years. The prevalence of diabetic foot ulcer was 15%. Patients who were either overweight or obese (OR 4.63, CI: 2.08-10.30), had a lack of family support in managing diabetes (OR 3.33, CI: 1.74-6.36), and did not check their feet regularly were more likely to develop DFU (OR 1.99, CI:1.08-3.66). Increased body mass index, lack of family support, and not checking feet regularly were associated with DFUs. The high prevalence of DFUs and the plethora of needs of people with DFUs pose challenges for health care. A coordinated health care system is necessary to meet the needs of diabetic patients and prevent DFUs.

Intelligent plantar pressure offloading for the prevention of diabetic foot ulcers and amputations.

The high prevalence of lower extremity ulceration and amputation in people with diabetes is strongly linked to difficulties in achieving and maintaining a reduction of high plantar pressures (PPs) which remains an important risk factor. The effectiveness of current offloading footwear is opposed in part by poor patient adherence to these interventions which have an impact on everyday living activities of patients. Moreover, the offloading devices currently available utilize primarily passive techniques, whereas PP distribution is a dynamically changing process with frequent shifts of high PP areas under different areas of the foot. Thus, there is a need for pressure offloading footwear capable of regularly and autonomously adapting to PPs of people with diabetes. The aim of this article is to summarize the concepts of intelligent pressure offloading footwear under development which will regulate PPs in people with diabetes to prevent and treat diabetic foot ulcers. Our team is creating this intelligent footwear with an auto-contouring insole which will continuously read PPs and adapt its shape in the forefoot and heel regions to redistribute high PP areas. The PP-redistribution process is to be performed consistently while the footwear is being worn. To improve adherence, the footwear is designed to resemble a conventional shoe worn by patients in everyday life. Preliminary pressure offloading and user perceptions assessments in people without and with diabetes, respectively, exhibit encouraging results for the future directions of the footwear. Overall, this intelligent footwear is designed to prevent and treat diabetic foot ulcers while enhancing patient usability for the ultimate prevention of lower limb amputations.

A Systematic Review of the Clinical Effectiveness of Aloe Vera for the Prevention and Treatment of Chronic Wounds

Aloe vera is an herbaceous and perennial plant that belongs to Liliaceae family and used for many medicinal purposes. Aloe vera have been associated with the treatment of skin burns and postoperative wound healing but not many clinical studies have been conducted to evaluate its effectiveness against chronic wounds such as pressure injury. The present study aimed to systematically review clinical trials investigating the effect of Aloe vera on the prevention and healing of chronic wounds. To identify all related published studies, Science Direct, Google Scholar, PubMed, and Ovid MEDLINE databases were searched in English language from the year 2015-2022. All clinical trials using Aloe vera gel, cream, or derivatives that included a control group with placebo or comparison with other treatments were included in the study according to the PRISMA selection process. In total, 11 trials that met the inclusion criteria were reviewed. The results of the studies showed successful use of Aloe vera in the prevention and treatment of chronic wounds including pressure injuries, chronic wound ulcers, diabetic foot ulcers, chronic anal fissures, and traumatic oral ulceration due to orthodontic appliances. Based on its safety and efficacy profile, this review concluded that Aloe verahas potential benefits to be used as a complementary or alternative treatment in chronic wounds along with conventional methods. Its ability to retain skin moisture and preservation of skin integrity supports its use in the prevention of ulcers.

A 15-year follow-up report of an elderly diabetic foot with multiple recurrences leading to toe amputation and thoughts on the model of care for diabetic foot ulcer.

Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Elderly diabetic patients are a high prevalence of diabetic foot ulcers, and their high recurrence, disability, and mortality rates impose a heavy economic burden on families and society. This paper reports a case of an elderly patient with a diabetic foot ulcer who was admitted in April 2007 and discharged after recovery from comprehensive diabetic foot treatment. Due to intermittent foot care and lack of home care, the patient's foot ulcers recurred after repeated healing during home rehabilitation, eventually resulting in the amputation of the right bunion. After the patient was discharged from the hospital with an amputated toe, the whole-process seamless management model of "hospital - community - family" was implemented. The hospital provides specialized foot support and guidance, and the community is responsible for daily disease management and referrals. The family is responsible for the implementation of home rehabilitation programs, and family caregivers need to identify and provide feedback on foot abnormalities promptly. As of May 2022, the patient had not experienced ulcer recurrence. This paper reports the whole process of "ulcer development → ulcer healing → ulcer recurrence healing → toe amputation → continuous care management" experienced by the patient in 15 years, aiming to reflect on the significance of the whole-process seamless foot care management model of "hospital-community-family" for diabetic foot ulcer rehabilitation through the case.

Diabetic Foot Ulcer (DFU) Gene Expression in Homo Sapiens Species

Diabetic foot ulcer (DFU) is a major problem in people with diabetes because more than 15% of patients have to treat DFU during their lifetime. 1 out of people with diabetes can experience a diabetic foot ulcer (DFU). At least a quarter of diabetic foot ulcer (DFU) sufferers cannot recover completely. The prevalence of diabetic foot ulcers (DFU) in Indonesia reaches 8.7%. The current DFU treatment approved by the FDA uses Becaplermin, a recombinant platelet-derived growth factor derivative. However, this treatment has a weakness in systemic bioavailability. FAgene expression analysis method is needed. to develop other therapies. This article aims to discover specific genes that play a role in diabetic foot ulcer (DFU) wound healing. In this systematic review, we searched the GEO Data Sets database to identify articles published from 2018 to 2023. The search results for DFU gene expression data for all species obtained 130 articles. Then, the DFU gene expression data series of Homo sapiens species was filtered to obtain ten related articles. This research has implications in providing better insight into the specific genes involved in the healing process of DFU wounds. This research also has the potential to contribute to early diagnosis of DFU injuries and better treatment.

Re-Emerging Tropical Disease: Our Local Experience with Mycobacterial Ulcers in Benin City, Nigeria

Buruli ulcer and other Mycobacteria infections especially Mycobacterium tuberculosis, involving the skin frequently occur in the tropics and have a lot in common in terms of their mode of presentation and extent of systemic involvements. Since the Yamoussoukro declaration, emphasis has been placed on the increasing prevalence of buruli ulcer; earning it a place among re-emerging diseases. Notwithstanding, other tropical ulcers continue to plague the region which are yet diagnosed or underdiagnosed. In developing countries where the burden of these mycobacterial infections is enormous, the problem of diagnosis and speciating these mycobacterial organisms continues to be a daunting task due to their similar mode of presentation and lack of appropriate labouratory facilities. A high index of suspicion based on detailed history, clinical presentations as well as therapeutic responses to treatment including anti-tuberculosis medication is time-saving and crucial in establishing a possible diagnosis in resource poor settings. This will help combat the burden of these infections and attendant complications and disfigurement associated with these tropical mycobacterial ulcers.

Prevalence of diabetic foot ulcers and assessment of foot care knowledge and practice among patients attending diabetic clinic of a tertiary hospital of eastern India

Background: Diabetic foot ulcer (DFU) is a dreaded complication holding huge health and socio-economic impacts and negative impacts on quality of life of individual, community and society as a whole yet carrying scope of preventive potential. The objectives were to find out the prevalence of diabetic foot ulcers and to assess gap in knowledge, foot care practices and their determinants. Methods: A cross-sectional study was conducted over three months among 310 diabetic outpatients of a medical college of an eastern Indian state. Data were collected with a validated questionnaire containing socio-demographics, clinical and behavioral factors, foot care knowledge and practice and SINBAD score was used for assessing diabetic ulcers. Results: Out of 310 participants, 44 (14.2%) had diabetic foot ulcer and 1/5th of them had SINBAD score ≥3 indicating severity. Knowledge level was poor among 245 (79.0%) and healthy foot habits were among only 70 (22.6%). Addiction, diabetes for ≥5 years, any associated non-communicable diseases, irregular treatment and follow-up care, unhealthy foot condition, improper foot wear, poor knowledge of the disease and unhealthy foot habits had significant association with occurrence of foot ulcers. Conclusions: Generation of awareness can bring about prevention of development of foot ulceration among diabetic patients and henceforth can avert risk of adverse consequences of it.

Cutaneous Manifestations, Clinical Characteristics, and Prognosis of Patients With Systemic Sclerosis Sine Scleroderma

Systemic sclerosis (SSc) sine scleroderma (ssSSc) is a subset of SSc defined by the absence of skin fibrosis. Little is known about the natural history and skin manifestations among patients with ssSSc. To characterize the clinical phenotype of patients with ssSSc compared with patients with limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) within the EUSTAR database. This longitudinal observational cohort study based on the international EUSTAR database included all patients fulfilling the classification criteria for SSc assessed by the modified Rodnan Skin score (mRSS) at inclusion and with at least 1 follow-up visit; ssSSc was defined by the absence of skin fibrosis (mRSS = 0 and no sclerodactyly) at all available visits. Data extraction was performed in November 2020, and data analysis was performed from April 2021 to April 2023. Main outcomes were survival and skin manifestations (onset of skin fibrosis, digital ulcers, telangiectasias, puffy fingers). Among the 4263 patients fulfilling the inclusion criteria, 376 (8.8%) were classified as having ssSSc (mean [SD] age, 55.3 [13.9] years; 345 [91.8%] were female). At last available visit, in comparison with 708 patients with lcSSc and 708 patients with dcSSc with the same disease duration, patients with ssSSc had a lower prevalence of previous or current digital ulcers (28.2% vs 53.1% in lcSSc; P < .001; and 68.3% in dcSSc; P < .001) and puffy fingers (63.8% vs 82.4% in lcSSc; P < .001; and 87.6% in dcSSc; P < .001). By contrast, the prevalence of interstitial lung disease was similar in ssSSc and lcSSc (49.8% and 57.1%; P = .03) but significantly higher in dcSSc (75.0%; P < .001). Skin telangiectasias were associated with diastolic dysfunction in patients with ssSSc (odds ratio, 4.778; 95% CI, 2.060-11.081; P < .001). The only independent factor for the onset of skin fibrosis in ssSSc was the positivity for anti-Scl-70 antibodies (odds ratio, 3.078; 95% CI, 1.227-7.725; P = .02). Survival rate was higher in patients with ssSSc (92.4%) compared with lcSSc (69.4%; P = .06) and dcSSc (55.5%; P < .001) after up to 15 years of follow-up. Systemic sclerosis sine scleroderma should not be neglected considering the high prevalence of interstitial lung disease (>40%) and SSc renal crisis (almost 3%). Patients with ssSSc had a higher survival than other subsets. Dermatologists should be aware that cutaneous findings in this subgroup may be associated with internal organ dysfunction. In particular, skin telangiectasias in ssSSc were associated with diastolic heart dysfunction.

1343-P: Decreasing Lifetime Prevalence of Diabetes-Related Foot Ulcers over 25 Years—Longitudinal Analyses of the Trøndelag Health Study (HUNT), Norway

Background and objectives: Data on time trends in diabetes-related foot ulcer (DFU) prevalence are limited. We aimed to determine trends in the lifetime prevalence of DFU in the Trøndelag Health Study (HUNT) conducted in three waves between 1995 and 2019. Research Design and Methods: This longitudinal population-based study consists of individuals ≥20 years with diabetes who participated in at least one of the three HUNT surveys from 1995-2019. Type 2 diabetes was defined as glutamic acid decarboxylase antibodies (GADA) &amp;lt;5 IU/mL (&amp;lt;0.09 ai) and age at diagnosis ≥30 years. Type 1 diabetes was defined as GADA ≥5 IU/mL (≥ 0.09 ai) and/or age at diagnosis &amp;lt;30 years. We used the following question to assess prevalence of DFU: “Have you had a foot ulcer that required more than three weeks to heal?”. The lifetime prevalence of DFUs was evaluated using cross-sectional data. Results: The total diabetes population was 1630 in HUNT2, 1824 in HUNT3 and 2393 in HUNT4. Approximately 85% of the participants had type 2 diabetes. Among those with type 2 diabetes, the lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 10.1% (8.5-11.8) in HUNT2, 7.4% (6.2-8.8) in HUNT3 and 5.0% (4.1-6.0) in HUNT4. Corresponding numbers in those with type 1 diabetes were 14.9% (11.1-19.8), 8.5% (5.4-13.3) and 7.2% (4.8-10.5), respectively. The decline in DFU prevalence persisted after adjusting for age, sex, educational level, marital status, work situation, body mass index, systolic blood pressure, smoking, and HbA1c. Conclusion: The results of this longitudinal population-based study suggest that the lifetime prevalence of DFUs in Norway has declined substantially during the past 25 years. Disclosure H.K.R.Riise: None. M.M.Iversen: None. J.Igland: Research Support; Pfizer Inc., Sanofi. M.Graue: None. A.Haugstvedt: Advisory Panel; Novo Nordisk. T.Ostbye: None. E.Søfteland: None. M.Hermann: None. S.Carlsson: None. B.O.Åsvold: None. Funding Western Norway Regional Health Authority (F-12131)

Microbial Prevalence and Outcome of Diabetic Foot Ulcers in Patient’s Candidates for Minor Surgical Interventions

Background: Diabetes mellitus is a progressive disease with chronic complications such as diabetic foot infection, a significant difficulty that inevitably leads to gangrene and amputations.&#x0D; &#x0D; Objective: This study aims to determine microbial prevalence in diabetic foot infections, identify the significance of aggressive surgical therapy and minor amputations in limb salvage and the prevention of more proximal amputations, and identify predicting factors affecting the outcome of these surgical processes.&#x0D; &#x0D; Methods: In this cohort study, microbiological samples were collected from 62 patients with diabetic foot lesions who underwent debridement or minor amputations to determine the prevalence of microorganisms in diabetic foot infections. Then, they were followed up to determine the rate of saved limbs and the factors that affect the outcomes and rate of complications.&#x0D; &#x0D; Results: infections were mainly caused by aerobic Gram-positive bacteria (S. aureus) 53.5%, and aerobic Gram-negative bacteria of enterobacter species 40.4%. Regarding the outcome of surgical intervention, we found an 80.65% success rate of saving the limb with a 30.6% complication rate. Risk factors such as high levels of inflammatory markers and parameters of the severity of peripheral arterial disease showed significant association with the rate of complications and poor outcomes.&#x0D; &#x0D; Conclusions: Debridement and minor surgical amputations effectively prevent more proximal amputations in diabetic foot infections with a high chance of good results. At the same time, the common microorganism in our local population was S. aureus, followed by P. mirabilis, E. coli, and Klebsiella species in diabetic foot infections.

The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal's Long-Term Care Units.

The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people's quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 "Floating so that staffing is equalised among units" is strongly associated with a shorter PU healing time. A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.

#4430 PREVALENCE OF AMPUTATION IN HD PATIENTS: A DIALYSIS PROGRAM WITHOUT SOCKS

Abstract Background and Aims Peripheral arterial disease affects very commonly CKD patients on dialysis. Frequently such injuries precede severe complications that lead to hospitalizations, amputations and even death. Objectives: Study the prevalence of ulcers and amputation on dialysis, analyze related risk factors, post-surgical results and establish a prevention program. Method Descriptive, observational, retrospective (7 years), single-center study in patients with CKD on dialysis. Results 202 patients (12 PD 190 HD), 67 active and 135 off dialysis, 127 men 75 women. Average age 69 years. Average time on dialysis 47 months. Vascular access: 56%, native fistula 37% catheter 7% prosthesis. Cause CKD 30,2% ND, 22.8% NAS. 95.54% HBP, 46.53% DM 26.73% Ischemic heart disease, 31.19% chronic ischemia, 26.24% had intermittent claudication, 12.38 % had all the comorbidities indicated. Higher comorbidity in males M:F 4:1. 53.47% ex-smokers or active habit. Ulcers 29.7% (40 men 20 women), 76.67%, diabetics. Half of the patients with DM (48.94%) presented ulcers. The most frequent was vascular ulcer (43.67%) followed by that associated with diabetic foot (26.67%) and pressure ulcer 15%. Amputations (11 major and 13 minor) in 24 patients (16 men 8 women) with a prevalence: overall 12%, DM 22.34%, with ulcers 40% and 46% if they are diabetics. Analytics in amputees. Average: PTH 352 ng/dl, Phosphorus 4.4 mg/dl, Vitamin D 19 mg/dl, Albumin 3.3g/dl, hypercholesterolemia in 20%. 17 patients with chronic ischemia were revascularized (76.47% ended in amputation). Mortality: 88 patients died (43.56%), of which 41 were patients with ulcers (68.33%) and 20 were amputees (83.33%, 3 early mortality and 17 late mortality). Conclusion The prevalence of amputations on dialysis is high. Most are male, DM with high cardiovascular comorbidity and a previous history of ulcers. Mortality increases in patients with CKDG5D with ulcers and amputees. There is a need for 11dialysis without socks” programs for early detection of dialysis ulcers to reduce the incidence of amputees.

Region-wise severity analysis of diabetic plantar foot thermograms.

Diabetic foot ulcers (DFU) can be avoided if symptoms of diabetic foot complications are detected early and treated promptly. Early detection requires regular examination, which might be limited for many reasons. To identify affected or potentially affected regions in the diabetic plantar foot, the region-wise severity of the plantar foot must be known. A novel thermal diabetic foot dataset of 104 subjects was developed that is suitable for Indian healthcare conditions. The entire plantar foot thermogram is divided into three parts, i.e., forefoot, midfoot, and hindfoot. The division of plantar foot is based on the prevalence of foot ulcers and the load on the foot. To classify the severity levels, conventional machine learning (CML) techniques like logistic regression, decision tree, KNN, SVM, random forest, etc., and convolutional neural networks (CNN), such as EfficientNetB1, VGG-16, VGG-19, AlexNet, InceptionV3, etc., were applied and compared for robust outcomes. The study successfully developed a thermal diabetic foot dataset, allowing for effective classification of diabetic foot ulcer severity using the CML and CNN techniques. The comparison of different methods revealed variations in performance, with certain approaches outperforming others. The region-based severity analysis offers valuable insights for targeted interventions and preventive measures, contributing to a comprehensive assessment of diabetic foot ulcer severity. Further research and development in these techniques can enhance the detection and management of diabetic foot complications, ultimately improving patient outcomes.

Contact Lens Use Advice-Risks and Outcomes: Are Patients Drowning in Information but Starved for Knowledge?

Microbial keratitis can cause significant visual morbidity and is a common reason for presentation to eye casualty clinics. Contact lens wear and poor contact lens hygiene significantly increase the risk of corneal infection. This study aimed to determine the level of contact lens hygiene awareness amongst contact lens wearers attending our service and determining whether contact lens type and hygiene attitude are related to severity of disease. This prospective questionnaire-based study included 50 consecutive patients attending the eye casualty clinic of a tertiary referral center. Visual acuity was assessed at presentation and 2 weeks after diagnosis. Patients were divided into subgroups according to contact lens type (monthly, bi-weekly, daily, and extended day and night wear) and risk group (low, medium, and high) depending on their contact lens hygiene practices. Thirty-four women and 16 men were included in this study. Twenty-four patients used monthly disposable contact lenses, 16 used daily disposable contact lenses, 6 were using bi-weekly replacement lenses, and 4 patients were using extended wear (day and night) contact lenses. Twenty-five patients were diagnosed with corneal ulcer, 23 of which had some degree of poor contact lens hygiene. Best corrected visual acuity (BCVA) significantly improved after treatment. Mean BCVA was 0.24 LogMAR before treatment and 0.09 LogMAR after treatment (p<0.05). Our study highlights the need to improve contact lens hygiene awareness and influence hygiene practices. Patients with the poorest contact lens hygiene had slower visual recovery and a higher prevalence of corneal ulcer. Contact lens hygiene advice needs to be clear and reinforced over time.

The Impact of Foot Care Education on Knowledge of Prevention the Risk for Diabetic Ulcers Among Diabetic Patients

Diabetic foot ulcers are the fastest growing chronic complications of diabetes mellitus, unmanaged diabetic complications such as diabetic foot ulcers will have a negative impact on the quality of life of individuals, health education, information and communication about DFUand foot care needs to be improved. The purpose of this study was to determine the impact of foot care education on knowledge of diabetic ulcer risk prevention in people with diabetes mellitus in the working area of the Mutiara Barat Health Center, Pidie Regency. This type of research is quasi-experimental research. The population in this study were all diabetes mellitus sufferers in the working area of the Mutiara Barat Health Center, Pidie Regency, in the last 1 month as many as 63 patients. Sampling was done purposive sampling technique as many as 25 people. The results showed that there was an effect of foot care education on knowledge of diabetic ulcer risk prevention in people with diabetes mellitus in the working area of the Mutiara Barat Health Center, Pidie Regency, which obtained a significance value of ρ = 0.001 where ρ &lt;0.05. Health education provides moderate to moderate knowledge in helping diabetes mellitus patients to increase their knowledge about diabetic foot ulcer prevention. It is hoped that good knowledge will raise awareness, will and strength, so that it can change the behavior of diabetes mellitus patients into adaptive behavior that can prevent diabetic ulcers from occurring.

Prevalence and risk factors of recurrent aphthous stomatitis among college students at Mangalore, India.

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases affecting an approximate 25% of the world's population. Some common etiological factors are genetics, nutritional deficiencies, stress and immune dysfunction. There is currently no specific medication to treat the condition but RAS tends to heal by itself within a week or two. We aimed to explore about the prevalence and related risk factors of recurrent aphthous ulcers among college students aged 18-30 years who had been affected within the preceding six months prior to the study duration. A questionnaire survey was conducted among 681 students from four colleges in Mangalore, Karnataka, India after obtaining the approval for the same from the respective colleges. Consenting participants returned a survey containing various questions. The collected data was then analyzed using descriptive statistics. The study was approved by the Institutional Ethics Committee. Of the 681 participants, 322 (47.2%) were affected with RAS in the past six months which included 131 (40.6%) males and 191 (59.3%) females. Single mouth ulcers were the most common presentation seen among the study participants (74.2%). Factors showing statistically significant association were: family history of RAS (P<0.001), known diabetics (P<0.001), history of smoking (P<0.001), oral trauma (P<0.001), history of wearing braces/dentures (P<0.001) as well as those using toothpastes containing sodium lauryl sulphate (P<0.001), stress and lack of sleep (P<0.001). The most common form of medication used were topical agents (43.1%) (P<0.001). There was a statistically significant association between the occurrence of RAS and family history of RAS, diabetes, smoking, history of braces/dentures, oral trauma, sodium lauryl sulphate toothpastes, lack of sleep, stress, menstruation, consumption of particular foods and beverages. Further research is needed in this field to truly understand the prevalence and risk factors of RAS and to help in discovering a treatment modality for this condition.

Evaluation of pharmaceutical use of chamomile in dentistry: A systematic review

Background: Oral mucosa is one of the body’s most sensitive tissues. Due to the prevalence of oral ulcers and the effect of cancers on the oral mucosa، treating oral lesions is particularly important. Matricaria chamomilla is widely used in traditional medicine. Chamomile compounds have antibacterial، antiviral، anti-inflammatory and accelerate epithelialization. However no systematic study has been undertaken on the application of chamomile in treating oral lesions. Therefore this study aims to determine the medicinal use of chamomile in dentistry.&#x0D; Methods: This systematic review searched major international electronic databases، including PubMed، ISI and Scopus، from August 1998 to August 2021. The articles included in this review were clinical trials in which the participants used chamomile as a mouthwash or gel.&#x0D; Results: In this study، the therapeutic effects of chamomile were evaluated in 14 clinical trial studies. Most of the studies reviewed in the articles referred to the properties of flavonoid compounds with anti-inflammatory and analgesic properties of chamomile.&#x0D; Conclusion: Today، medicinal plants are used in treatment and one of the most common plants used for medicinal purposes is chamomile. It is used in dentistry، and its positive effects on plaque، gingivitis، caries، mucositis and its antibacterial effects have been reported.

Decubitus Ulcers in Patients with Spinal Cord Injury in Different Hospitals of Lahore

BACKGROUND: Spinal cord damage is a debilitating nervous disorder that has a significant economic, social, and psychological burden on those who are affected as well as the healthcare system. The spinal cord can be damaged due to either trauma to the cord or spinal cord dysfunctions. Pressure injuries are the leading secondary complication in patients with spinal cord injuries. OBJECTIVE: The purpose of this research was to document the prevalence of decubitus ulcers in spinal cord injury patients. METHOD: It was a cross-sectional study that included a sample of 114 patients either male or female with traumatic spinal cord injury or non-traumatic spinal cord injury with age ranging from less than 12 years to greater than 89 years from various hospitals in Lahore. The sampling technique used was non-probability convenient sampling. Written consent was taken from all patients before the collection of data. Pressure ulcer assessment was done using the European pressure ulcer prevalence study questionnaire. Data were analyzed using the IBM SPSS STATISTICS-25.0 version. Categorical variables were presented as frequencies and percentages, with the use of bar charts or pie charts. RESULTS: Out of 114 patients 68 patients were male (59.6%) and 46 were female (40.4%). This study concluded that 58.9% of patients had decubitus ulcers whether severe or at stage one of PU as a secondary complication of spinal cord injury. From the total sample of 114 patients 49.9% of participants had the most severe decubitus ulcers mostly on the sacrum which can lead to infection and requires surgical interventions such as debridement. Stage 1 decubitus ulcers were seen on the elbow and back. CONCLUSION: More than half of the patients included in this study had one or more pressure ulcers that can be damaging to their health and quality of life. In developed and developing countries pressure ulcers are widespread but are preventable.&#x0D; Key Words:&#x0D; Spinal cord injury, pressure ulcer, sacrum&#x0D;