Ulcer Prevention Research Articles

THE CORRELATION OF SERUM ALBUMIN LEVELS AND STAGES OF DECUBITUS IN INPATIENTS AT DR. SOETOMO REGIONAL GENERAL HOSPITAL OF SURABAYA

Introduction : The prevalence of decubitus ulcers in Asia is amounted to 2.7%-16.8%, and in Indonesia, there was a 40% prevalence of decubitus ulcers in 2017. In 2017, the prevalence of decubitus in Bandung was found to be 10.8%. Consequently, the number of active cases and deaths of decubitus ulcers reached 48%. Therefore, efforts to reduce the number of decubitus ulcers are urgently needed, thereby preventing the risk of decubitus severity. Objective: To evaluate the correlation of serum albumin levels and stages of decubitus in inpatients at Dr. Soetomo Regional General Hospital of Surabaya Method: This research was successfully carried out by means of observational analytics, with a cross-sectional research design. Moreover, this research data were derived from medical record data of inpatients at Dr. Soetomo Regional General Hospital of Surabaya in the period of January 2018 – December 2020, with a total of 144,002 patients. 197 decubitus patients in Pandan I and Pandan Wangi rooms were involved in the sample selection process. Based on the inclusion and exclusion criteria, 57 patients were finally determined as research samples. Samples were selected by utilizing Simple Random Sampling. The number of samples in the case group and control group was amounted to 39 patients, respectively. The data of this research were then analyzed using the Spearman Correlation test. Result: The research results indicated that the least number of decubitus patients at stage I was amounted to 8 people (10.3%), and the highest number of decubitus patients at stage III was amounted to 12 people (15.4%). Furthermore, the results of the Spearman correlation test showed that there was a significant correlation of serum albumin levels and stages of decubitus (p = 0.002). Conclusion: There was a significant correlation of serum albumin levels and stages of decubitus in inpatients at Dr. Soetomo Regional General Hospital of Surabaya in the period of January 2018 – December 2020.

Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia.

ObjectiveWe aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia.MethodsWe performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice.ResultsThe prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42–15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86–6.97), lack of regular exercise (3.91; 1.51–10.10), peripheral neuropathy (2.77; 1.05–7.33) and foot calluses (5.69; 1.74–18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09–3.69), patients with diabetes for >10 years (2.92; 1.48–5.77), women (2.95; 1.66–5.22), and patients with a glucometer at home (2.05; 1.09–3.85) were more likely to have good foot self-care practice.ConclusionThe prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.

S1584 Prevalence of Non-Helicobacter pyloriPeptic Ulcers in Patients With Chronic Pancreatitis: A Population-Based National Study

Introduction: Acute and chronic pancreatitis are recognized as a continuum of the same disease, with a significant overlap in clinical manifestations. The association between peptic ulcer disease (PUD) and acute pancreatitis (AP) has been described in the literature. However, there is no available data on the prevalence of PUD in patients with chronic pancreatitis (CP). Methods: The aim of this study was to investigate if CP is associated with increased overall risk of PUD, gastric ulcers, and duodenal ulcers. Data was collected from a commercial database (Explorys Inc, Cleveland, OH), an aggregate of EHR data from 27 integrated healthcare systems in the US between 12/2016-12/2021. We identified patients with CP based on Systemized Nomenclature of Medicine – Clinical Terms and excluded patients with Helicobacter pylori infection of the gastrointestinal tract. We compared the prevalence of peptic ulcer, gastric ulcer, and duodenal ulcer after at least 30 days following a diagnosis of CP to a cohort without CP. Results: Of the 33,660,510 patients in the database without H. pylori, we identified 66,550 cases of CP. We identified 2,480 cases of peptic ulcer, 2,680 cases of gastric ulcer and 1,420 cases of duodenal ulcer in patients with CP. In comparison, we identified 160,270 cases of peptic ulcer, 201,600 cases of gastric ulcer and 81,920 cases of duodenal ulcer in patients without CP. Overall prevalence for peptic ulcer, gastric ulcer, and duodenal ulcer in patients with CP was 3727/100000, 4027/100000 and 2134/100000 people, respectively. In comparison, overall prevalence for peptic ulcer, gastric ulcer, and duodenal ulcer in patients without CP was 477/100000, 600/100000 and 244/100000 people, respectively. The prevalence ratios (PR) for developing each diagnosis after at least 30 days of a CP diagnosis were 7.81 (95% CI 7.51-8.12, P< 0.001), 6.71 (95% CI 6.47-6.97, P< 0.001), and 8.75 (95% CI 8.31-9.22, P< 0.001), respectively. Table 1 describes the prevalence of PUD among various demographics. Conclusion: In this large population-based study, peptic ulcer, gastric ulcer, and duodenal ulcer were all significantly more prevalent among patients with a diagnosis of CP. Future investigation will be useful in understanding the pathophysiology of this association. Table 1. - Prevalence of peptic ulcer, gastric ulcer and duodenal ulcer in patients with and without chronic pancreatitis Chronic Pancreatitis (CP) No CP Prevalence in CP /100,000 Prevalence in No CP /100,000 Prevalence Ratio 95% CI P-value Peptic Ulcer 2480 160270 3726.52 477.08 7.81 7.51-8.12 < 0.001 Adults (18-65) 1640 74130 3964.23 374.11 10.60 10.1-11.1 < 0.001 65)"}" > Elderly ( >65) 840 85440 3362.69 1088.74 3.09 2.89-3.30 < 0.001 Caucasian 1700 119480 3739.55 657.53 5.69 5.43-5.96 < 0.001 African American 670 24730 5153.85 648.38 7.95 7.38-8.57 < 0.001 Asian 20 2860 2985.07 536.31 5.57 3.61-8.58 < 0.001 Male 1210 64750 3587.31 434.60 8.25 7.81-8.73 < 0.001 Female 1270 95450 3861.36 516.79 7.47 7.08-7.89 < 0.001 Gastric Ulcer 2680 201600 4027.05 600.11 6.71 6.47-6.97 < 0.001 Adults (18-65) 1730 88420 4181.77 446.23 9.37 8.95-9.82 < 0.001 65)"}" > Elderly ( >65) 940 112280 3763.01 1430.75 2.63 2.47-2.80 < 0.001 Caucasian 1830 149090 4025.52 820.48 4.91 4.69-5.13 < 0.001 African American 740 28950 5692.31 759.02 7.50 6.99-8.05 < 0.001 Asian 30 3690 4477.61 691.96 6.47 4.56-9.19 < 0.001 Male 1260 77990 3735.55 523.46 7.14 6.76-7.54 < 0.001 Female 1420 123300 4317.42 667.58 6.47 6.15-6.81 < 0.001 Duodenal Ulcer 1420 81920 2133.73 243.85 8.75 8.31-9.22 < 0.001 Adults (18-65) 860 31370 2078.80 158.31 13.10 12.3-14.0 < 0.001 65)"}" > Elderly ( >65) 560 49880 2241.79 635.61 3.53 3.25-3.83 < 0.001 Caucasian 960 60480 2111.75 332.84 6.35 5.96-6.76 < 0.001 African American 400 11250 3076.92 294.96 10.40 9.46-11.5 < 0.001 Asian 20 1720 2985.07 322.54 9.26 6.00-14.3 < 0.001 Male 850 45120 2520.01 302.84 8.32 7.78-8.90 < 0.001 Female 570 36660 1733.05 198.49 8.73 8.04-9.48 < 0.001

Prevalence of Recurrent Aphthous Ulcers (RAUs) in the Population of Ludhiana

Introduction: Recurrent aphthous ulcer (RAU) is one of the most common oral mucosal disorders characterized by recurrent and painful ulcerations on movable or nonkeratinized oral mucosa. It affects approximately 20% of the general population. These present as recurrent, multiple, small, round, or ovoid ulcers with circumscribed margins, having yellow or gray floors, surrounded by erythematous halos. Aims and Objectives: To compare the prevalence and occurrence of RAU among the age group from 20 to 80 years. To compare the prevalence and occurrence among the gender. To correlate the causes of the recurrent aphthous stomatitis (RAS). To check for tobacco and its role in the occurrence of RAS. Materials and Methods: A cross-sectional study was conducted, and a total of 600 questionnaire forms were distributed and filled by students (undergraduates and postgraduates), staff, skilled workers, and patients reporting to the department over a period of 3 years. Results and Discussions: In total, 71.1% had experienced oral aphthous ulcerations. When both the genders were compared, RAS more commonly affected females (60.33%) than males (39.67%). The regression coefficient for gender revealed that females were more prone to RAS than males. Conclusion: Understanding the prevalence and distribution of recurrent aphthous ulceration among the population of Ludhiana gives an indication of the section of people who suffer from the condition. Based on the results of our study, females were more commonly affected than males, and the second- and third-decades age groups were affected.

S426 POEM Results in More Frequent and More Severe Reflux Than Heller Myotomy

Introduction: Achalasia is an esophageal motility disorder that is characterized by abnormal lower esophageal sphincter (LES) relaxation due to disrupted neuromodulatory responses. Relieving this outflow obstruction simultaneously disrupts the barrier against gastroesophageal reflux (GER). There is a need for comprehensive studies describing the comparative incidence of abnormal GER accounting for both pH testing and esophagogastroduodenoscopy (EGD) findings and specifically examining the incidence of severe reflux in peroral endoscopic myotomy (POEM) compared to laparoscopic Heller myotomy with Dor fundoplication (LHM). Methods: The charts of patients who underwent LHM or POEM between 2017 and 2019 at our institution were reviewed, and patients who had completed a 2-month post-treatment esophageal pH study off acid-lower agents were included. We also included patients who underwent EGD but did not undergo pH monitoring due to finding erosive esophagitis. Patients with a history of prior myotomy or who underwent Heller without Dor fundoplication were excluded. Results: Of the 236 patients included, 85 (36%) had undergone POEM while 151 (64%) had undergone LHM. The prevalence of abnormal gastroesophageal reflux using pH testing (TAE >4%) is 62% for POEM and 21% for LHM. When including abnormal EGD’s, the prevalence of abnormal GER (TAE >4% or reflux esophagitis or esophageal ulcer) becomes 72% and 28%, respectively. The incidence of severe reflux (defined by more than 10% time in reflux overall or Grade C/D esophagitis or esophageal ulcer) is 38.8% for POEM and 15.2% for LHM. The prevalence of gastritis was 7.9% in LHM vs 2.4% in POEM (NS), with a prevalence of gastric and duodenal ulcers of 2.6% in LHM vs 0% in POEM, but these were not statistically significant (Table). Conclusion: POEM is associated not only with a significantly higher incidence of abnormal GER (72% vs 28%, p< 0.001), but also with a higher incidence of severe GER (38.8% vs 15.2%, p< 0.001), accounting for both esophageal pH testing and upper endoscopy findings. Gastroenterologists should be aware of this association and follow post-POEM patients carefully given the risk of developing significant pathology due to severe reflux. Table 1. - Incidence of gastroesophageal reflux (GER) by different measures in POEM as compared to LHM Characteristic POEM LHM p-value TAE time >4% 62.4% 20.5% < 0.001 TAE time >10% 35.3% 10.3% < 0.001 Grade A/B esophagitis 17.6% 9.3% NS Grade C/D esophagitis 2.4% 6.6% 0.03 Esophageal Ulcer 1.2% 0.7% NS Gastroduodenal pathology* 2.4% 10.6% 0.022 Abnormal GER** 72% 28% < 0.001 Severely abnormal GER*** 38.8% 15.2% < 0.001 p-value significant if p4% or esophagitis. Severely abnormal GER was defined as TAE >10% or Grade C/D esophagitis or esophageal ulcer.

ACHILLES TENOTOMY FOR CHRONIC NON-HEALING DIABETIC FOOT ULCERATION: A CASE SERIES

The prevalence of non-healing diabetic foot ulcers in increasing and its management continues to be a challenge with high rates of progression and recurrence. The Achilles tendon in diabetics undergoes microscopic reorganization leading to its shortening. The resulting equinus deformity, combined with neuropathy and arthropathy, may cause pressure ulcers to form on the plantar aspect of the forefoot. Without ofoading the pressure at these points, the lesions remain open. Lengthening of the Achilles tendon restores normal range of motion of the ankle and decreases pressure facilitating ulcer healing. This short, same day procedure, done under local anaesthesia allows immediate extension of the tendon. Fourteen patients with non-healing ulcers had tenotomies. Ankle dorsiexion before and after was documented and time taken for the ulcers to heal post operatively recorded. All patients showed immediate improvement in the amount of ankle extension postoperatively; ulcer healing was achieved on average by 8 weeks. One patient has recurrence of ulceration at 15 months postoperatively. Follow up time was 18 months. Achilles tendon lengthening is an easy, safe, same day procedure for diabetic patients and should be considered as an option for non-healing pressure ulcers to the soles of their feet.

Nursing students’ knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia

ObjectiveThe prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students’ knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them. MethodsA cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis. ResultsThe results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96–20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19–0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40–5.41, P = 0.003). ConclusionFindings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students’ knowledge and attitudes based on the factors discovered in this study.

Prevalence of people with sickle cell disease and leg ulcers in Brazil: Socioeconomic and clinical overview.

ObjectiveTo identify the prevalence of people with leg ulcers resulting from sickle cell disease, as well as to describe the clinical, social, economic, and demographic conditions of these people.MethodDescriptive study, carried out at the Minas Gerais Hematology and Hemotherapy Center Foundation. The study population consisted of individuals over the age of 18 with a diagnosis of sickle cell disease in the State of Minas Gerais, Brazil. Data collection was performed from August 2019 to April 2020 through interviews. For the prevalence calculation, a census was taken of 5,379 people over the age of 18 with sickle cell disease, 77 of whom had active leg ulcers. Descriptive data analysis was performed using SPSS software (version 20.0, Chicago, IL, USA).ResultsThe prevalence of people with leg ulcers in Minas Gerais, Brazil was 1.4%. Of the 72 respondents, the average age was 39 years (range 18–64 years), 41.7% were single, 48.6% said they were black, 84.7% lived in their own house, 38.9% were retired, 61.1% had an income of one minimum wage. The median years of education was 10.5, 50% cited the church as a place for leisure activities, 79.2% denied smoking. Regarding pain, the median score was 3, the median baseline hemoglobin was 7.7 g/dL, and 91.7% had the HbSS genotype. The median age of the first ulcer was 18 years, 77.8% of active ulcers were recurrent, and 59.7% had only one active ulcer. The median time of existence of the ulcer was 3 years. The ulcer prevented 80.6% of people from doing some activity. Prejudice was experienced by 48.6% of the participants.ConclusionThe estimated prevalence of leg ulcers was lower than what it reported in the literature, however, the recurrence and the duration of ulcers were high. These findings bring reflection about the assistance to people with leg ulcer.

Incidence, prevalence, and potential risk factors for diabetic foot ulceration: A retrospective review at a multidisciplinary centre in Barbados.

Diabetes and lower extremity amputation rates in Barbados are among some of the highest globally, with peripheral neuropathy and peripheral vascular disease found to be independent risk factors for this population. Despite this, there is currently a lack of research evidence on rates of diabetic foot ulceration, which has amputation as its sequela. We aimed to evaluate the incidence and prevalence rates of active ulceration in a population of people with diabetes in Barbados. Secondly, we explored the risk factors for new/recurrent ulceration. Data were extracted from the electronic medical records for the period January 1, 2019 to December 31, 2020 for a retrospective cross-sectional study for patients of a publicly-funded diabetes management programme. Eligible records included people aged 18 years and above with a diagnosis of type 1 or 2 diabetes. Potential risk factors were explored using univariable logistic regression models. A total of 225 patients were included in the study (96% type 2 diabetes, 70.7% female, 98.7% Black Caribbean). The 1-year period prevalence of diabetic foot ulceration was 14.7% (confidence interval [CI]: 10.5, 20.1). Incidence of ulceration in the same period was 4.4% (CI: 4.4, 4.5). Risk factors associated with diabetic foot ulceration included: retinopathy (OR 3.85, CI: 1.24, 11.93), chronic kidney disease (OR 9.86, CI: 1.31, 74.22), aspirin use (OR 3.326, CI: 1.02, 10.85), and clopidogrel use (OR 3.13, CI: 1.47, 6.68). This study provided some insight into potential risk factors for foot ulceration in this population, which previous studies have shown to have higher rates of lower extremity amputations. Further research in this understudied group through a larger prospective cohort would allow more meaningful associations with risk factors and would be useful for the creation of risk prediction models.

Prevalence of Recurrent Aphthous Ulcers Among Dentistry Students' in Kabul, Afghanistan: A Questionnaire-Based Study.

IntroductionRecurrent aphthous stomatitis (RAS) is the mouth’s most common and painful inflammatory ulcerative condition, also called aphthae or canker sores. Its prevalence is about 20% and predisposition factors involve genetics, environmental factors, and immune dysfunctions.ObjectiveReviewing the literature and no study was found to show the prevalence and associated factors of recurrent aphthous ulceration in the context of Afghanistan. Therefore, this study aimed to determine the lifetime prevalence and associated factors of recurrent aphthous ulceration among dentistry students at Kabul University of Medical Sciences, Afghanistan.MethodsA cross-sectional questionnaire-based study was carried out among 223 dentistry students. A descriptive and inferential analysis was performed to find the association.ResultsThe prevalence of (RAS) in our sample group was 30%. (68.7%) of participants had one or more family members who experienced aphthous ulcers and the association was found to be significant (X2 = 134.940; p < 0, 05). (81%) of participants experienced the condition to eating certain types of food (X2 = 165.906; p < 0, 05) and (53.7%) of them reported the same about trauma (X2 = 99.958; p < 0, 05). Regarding stress the difference was also statistically significant (X2 = 56.830; p < 0, 05).ConclusionWe found that a considerable proportion of the study sample had experienced recurrent aphthous ulceration. Family history, stress, trauma, and dietary factors have an impact on the occurrence of RAS with no association with gender and smoking.

Ischial and Sacral Pressure Ulcers

Background: Pressure ulcers remain a challenge for plastic surgeons to effectively manage because of the patient's underlying physical condition, weakness, risk factors associated with the diagnosis, and resultant insufficient wound healing that results in incomplete treatment or recurrence after surgery. This review describes and analyzes the current literature regarding the management of pressure ulcers.Methods: Risk factors primarily associated with wound dehiscence and recurrence were identified via a PubMed literature search using “ischial pressure ulcers, sacral pressure ulcers, and surgical coverage” as keywords. We analyzed and compared them to data from the Committee of the Japanese Society of Pressure Ulcers in 2016 and our facility.Results: Many published reports contain pedagogical comments on the successful management of pressure ulcers that remain significant. Some reported risk factors associated with flap dehiscence and ulcer recurrence are age, low serum albumin levels, previous operative failures at the same site, and ischial ulcers. The prevalence of deep pressure ulcers at the sacrum was more than three times higher than that at any other site. At our facility, the most frequently performed surgeries were for ischial ulcers, and 86% of pressure ulcers healed after surgery.Conclusions: Surgical site infection and surgical time were independent risk factors associated with wound dehiscence in the early phase after reconstruction. The effectiveness of closed wound management with negative-pressure wound therapy has been reported to be satisfactory for reconstructive surgeries with flaps for refractory pressure ulcers.

P-059: TRIAL IN PROGRESS: THE RANDOMIZED, DOUBLE-BLIND, MULTICENTER, PLACEBO-CONTROLLED PHASE 3 RESOLVE TRIAL INVESTIGATING THE EFFICACY OF VOXELOTOR WITH STANDARD OF CARE IN THE RESOLUTION OF LEG ULCERS IN PATIENTS WITH SICKLE CELL DISEASE

Purpose: Sickle cell disease (SCD) is a heritable blood disorder caused by a point mutation in the β-globin gene. Polymerization of deoxygenated mutated hemoglobin is the major molecular process in SCD pathogenesis that leads to red blood cell sickling and hemolysis. In addition to the major complications of SCD—hemolytic anemia, inflammation, and vascular occlusion—patients often experience secondary complications such as stroke, organ damage, shortened lifespan, and painful and debilitating skin ulcers. The prevalence of leg ulcers among people with SCD is likely underestimated, given the lack of registries and large prospective studies examining this complication. Current estimates of leg ulcers vary widely by geographic region: 43% in Brazil, 30% in Jamaica, 27% in Nigeria, 19% in Ghana, 13% in Sierra Leone, 8% in Saudi Arabia, and 1%-5% in the US. Among Americans with SCD, an estimated 14%-18% may develop leg ulcers. Voxelotor, a sickle hemoglobin polymerization inhibitor, is approved in the US for the treatment of SCD in adults and pediatric patients aged ≥4 years and in the EU for the treatment of hemolytic anemia due to SCD in adults and pediatric patients aged ≥12 years as a monotherapy or in combination with hydroxycarbamide. In a post hoc analysis of voxelotor-treated patients from the phase 3 HOPE study (NCT03036813), leg ulcers resolved within 24 weeks in 10 out of 14 patients, and leg ulcers improved or resolved in 13 out of 14 patients by week 72. Materials and methods: RESOLVE is an ongoing phase 3, randomized, double-blind, placebo-controlled, multicenter trial investigating the efficacy of voxelotor with standard of care (SOC) in the resolution of leg ulcers in patients with SCD. Target enrollment is 80 patients from Nigeria, Kenya, and Brazil with a confirmed diagnosis of SCD (HbSS or HbSβ0 genotype), aged ≥12 years, and with ≥1 cutaneous ulcer on the lower extremity (leg, ankle, or dorsum of foot) that meets the following criteria: ≥2 weeks’ and <6 months’ duration at screening and >2 cm2 in area before randomization. After a 2-week run-in period, participants are randomized 1:1 to receive once-daily oral voxelotor 1500 mg or placebo in addition to SOC for 12 weeks. After the randomized treatment period, all participants receive open-label voxelotor 1500 mg plus SOC for 12 weeks (Figure). Results: The primary objective of the study is to assess the efficacy of voxelotor plus SOC compared with placebo plus SOC on leg ulcer healing, measured by the proportion of patients with resolution of target ulcer(s) in each treatment group by week 12. Key secondary endpoints include days to resolution of target ulcer(s) up to week 12, change from baseline in total surface area of target ulcer(s) at week 12, and incidence of new ulcers by week 12. Conclusion: Results from this study will further guide clinicians and patients regarding the clinical use of voxelotor for the treatment of leg ulcers in patients with SCD. Participants will have the option to enroll in a separate open-label extension study after the 24-week treatment period.Figure. RESOLVE Study Design, Population, and Timeline J. DOSS declares a conflict of interest: Stock shareholder: Global Blood Therapeutics, Roche

Prevalence of foot ulcers in diabetic patients in Punjab, Pakistan.

Diabetes-related foot ulceration is prevalent and disabling, usually resulting in the amputation of the limb. The mortality rate is significant, and healed ulcers frequently reoccur. The main purpose of this study was to explore the prevalence of foot ulcers and their associated factors among diabetic patients in Punjab, Pakistan. Multistage cluster random sampling procedure was applied to perform a cross-sectional analysis in the state of Punjab, Pakistan. A sample of 1,503 people with diabetes, including 504 men and 999 women, were selected from different clusters. Data were collected from December 18, 2018, to June 30, 2019. Individuals of 18 years or above were selected. A binary multiple logistic regression analysis was utilized to find the factors associated with a diabetic foot ulcer. The overall prevalence of diabetic foot ulcers was 16.83% (95% CI: 14.9–18.7%). The prevalence among the female was 17.52% (95% CI: 15.2–19.9%), and the male was 15.48% (95% CI: 12.3–18.6%). In rural areas, prevalence was 13.91% (95% CI: 10.6–17.2%) compared to the prevalence of 17.96% (95% CI: 15.7–20.2%) in the urban area. Individuals 75 years and above had the highest prevalence of 66.67% (95% CI: 51.9–81.5%). According to the income status, subjects with monthly income above Rs. 61,000 had a prevalence of 24.24% (95% CI: 15.8–32.7%), and among overweight subjects was 25.49% (95% CI: 21.3–29.7%). This study found a relatively high prevalence of foot ulcers in Punjab, Pakistan. The results indicate that diabetic foot ulcers have become a major health problem in diabetic patients, and better strategies and preventive measures should be opted to deal with the epidemic.

Evidence implementation across Europe: the challenge of collaboration during the pandemic.

Evidence implementation across Europe: the challenge of collaboration during the pandemic.

Prevalence and prediction of pressure ulcers in admitted stroke patients in a tertiary care hospital

Pressure ulcer (PU) is a localized injury to the skin or underlying tissues usually over a bony prominence, which results due to pressure or pressure in combination with shear. It is an expensive health care problem that have deterring impact on the length of hospitalization and cause extra nursing care time. Moreover, PUs negatively impacts patients’ health related quality of life. High PUs prevalence figures were found in specialized hospital units such as intensive care unit (ICU), orthopedics, surgery, and also in stroke patients in medical units. The major purpose of this study is to assess the frequency of pressure ulcers in stroke patients at Ayub teaching hospital. The methodology used for carrying out the research was cross-sectional study conducted during months of September, October, and November 2020. Questionnaire was used to collect the data and well-informed written consent was taken from the patients. A total of 120 stroke patients were initially included with the intention to study the frequency of PUs among them. Different age groups were taken but majority (48.3%) belonged to the age group 31–60 years. Maximum patients were hypertensive (65%), while few of them were diabetic (35%). From the results of proposed work, it is found that out of 120 stroke patients, 75.8% presented with ischemic stroke while 24.2% presented with hemorrhagic stroke. 8.3% that is 10 out of 120 stroke patients developed pressure ulcers of grade 1 (1.7%), grade 2 (1.7%), grade 3 (2.5%), and grade 4 (2.5%) mostly in the sacral region (6.7%) and also on ankle (0.8%), and shoulder (0.8%) respectively. Patients in the study group had unsatisfactory hygiene (6.7%) were malnourished (11.7%) and were not using preventive mattresses (79.2%). Those at the risk of developing pressure ulcers were not being repositioned (6.7%) and did not had awareness (10%). Prevention and treatment used in ward is 100%. Conclusively, the frequency of pressure ulcers in stroke patients was determined to be 8.3% and the most frequent localization was sacrum. The PU care in this hospital is appropriate but still could be improved further by improving risk assessment, prevention specially use of air mattress and patient education regarding PUs. The main objective of the study is to identify the frequency of PUs in stroke patients and to highlight various factors that would avoid PUs development.

Prevalence of neurotrophic keratopathy in patients with chronic ocular graft-versus-host disease

PurposeTo determine the prevalence, clinical characteristics, and risk factors associated with neurotrophic keratopathy (NK) in patients with chronic ocular graft-versus-host disease (oGVHD). DesignRetrospective cohort study. MethodsWe performed a chart review of patients diagnosed with chronic oGVHD between January 2015 and December 2018 at a single academic institution and recorded demographic data, systemic and ocular comorbidities, history of hematologic malignancy, transplant characteristics, oGVHD severity scores, and adnexal and ocular examination findings. We determined the prevalence of NK and clinical characteristics associated with NK in these patients. A multivariate logistic regression analysis was performed to determine the risk factors associated with NK in these patients. Main outcome measurePrevalence of NK in chronic oGVHD. ResultsWe identified 213 patients diagnosed with chronic oGVHD following hematopoietic stem cell or bone marrow transplantation from our electronic patient database, and the prevalence of NK was 14%. The mean age of oGVHD patients with NK was 62.6 ± 12.9 years; 48% were women, 19 had unilateral NK, and ten had bilateral NK. In the cohort, 56%, 20%, and 24% eyes of the patients had grades 1, 2, and 3 of NK, respectively. The mean time to diagnose NK after transplantation was 52.9 ± 45.4 months. oGVHD patients diagnosed with NK had a significantly higher NIH oGVHD severity score (p = 0.04) and a lower corneal sensation score (p = 0.0001) than those without NK. Our analyses showed a significantly higher CFS score (p = 0.01) and a trend toward lower Schirmer test scores (p = 0.16) and tear break-up times (p = 0.08) in oGVHD patients with NK. Additionally, we observed a significantly higher prevalence of persistent epithelial defect (p = 0.0001), corneal ulceration (p = 0.0001), and corneal perforation (p = 0.005) in oGVHD patients diagnosed with NK. A logistic regression analysis to determine factors associated with NK showed that a higher NIH oGVHD score (odds ratio [OR] = 2.03, p = 0.026) and history of cataract surgery (odds ratio [OR] = 5.03, p = 0.001) are significant risk factors for NK in oGVHD patients. ConclusionsThe prevalence of NK in chronic oGVHD patients was 14% during the study period. Our analysis shows that oGVHD patients with a higher NIH oGVHD severity score and previous history of cataract surgery are at a higher risk of developing NK and may develop severe sequelae such as persistent epithelial defect or corneal ulceration.

Gastroprophylactic Effects of p-Cymene in Ethanol-Induced Gastric Ulcer in Rats

The prevalence of gastric ulcers has increased in recent years, mainly because of non-steroidal anti-inflammatory drug utilization. Therefore, the current study investigates the gastroprotective effect of p-Cymene on absolute ethanol-induced acute gastric mucosal hemorrhagic lesions in rats. Thirty Sprague Dawley rats were randomly separated into five groups: normal control, ulcer control, reference, and two experimental groups. The normal and ulcer control groups were orally fed with 0.5% carboxymethylcellulose (CMC). The reference group was fed orally with 20 mg/kg omeprazole. The experimental groups were fed with 30 mg/kg and 60 mg/kg p-Cymene, respectively. After one hour, the normal group was fed with 0.5% CMC, and groups 2–5 were given absolute alcohol. After another hour all rats were sacrificed. The ulcer control group showed severe superficial hemorrhagic gastric mucosal lesions with decreased gastric mucus secretion and pH of gastric content. p-Cymene significantly reduced ethanol-induced gastric lesions, as evidenced by increased mucus and pH of gastric content, decreased ulcer area, reduced or absence of edema, and leucocyte infiltration of the subcutaneous layer. In gastric mucosal homogenate, p-Cymene displayed a significant increase in superoxide dismutase (SOD), catalase (CAT) activities, prostaglandin E2 (PGE2), and significantly reduced the malondialdehyde (MDA) level. In addition, p-Cymene increased the intensity of periodic acid–Schiff (PAS) stain of the gastric epithelium, and produced up-regulation of the HSP 70 protein and down-regulation of the Bax protein of the stomach epithelium, as well as a reduction in the levels of tumor necrotic factor-alpha and interleukin-6, while the level of interleukin-10 was increased. p-Cymene decreased the level of TNF-a and IL-6, and increased the level of IL-10. Acute toxicity with a higher dose of 500 mg/kg p-Cymene did not manifest any toxicological signs in rats and could enhance defensive mechanisms against gastric mucosal lesions. p-Cymene showed gastroprotective effects that could be attributed to its antioxidant nature, or its ability to increase mucus secretion, increase endogenous enzymes (SOD, CAT, PGE2), reduce MDA level, up-regulate HSP 70 protein, down-regulate Bax protein, and modulate inflammatory cytokines.

Reduction of home-acquired pressure ulcers among palliative patients using quality tools and techniques

Pressure ulcers (PU) are a substantial health problem, and they are considered a surrogate for compromised quality care. The prevalence of pressure ulcers in palliative patients is significantly high due to altered skin integrity, mobility issues and chronic diseases.[1,2][1] Pressure ulcers

EVALUATION OF ANTIULCEROGENIC EFFECT OF CRYOCONSERVATED PLACENTA EXTRACT ON THE MODEL OF ETHANOL-PREDISONOLIC LESIONS OF THE GASTRIC MUCOSA

Relevance. Gastric and duodenal ulcers occur in 6-10% of the adult population, and mortality from peptic ulcers ranges from 5 to 15%. Conservative treatment of this disease almost always involves the use of antisecretory and antibacterial drugs. Existing treatment regimens for peptic ulcer disease, focused on key pathogenetic mechanisms, do not take into account the individual adaptive and trophological characteristics of patients. As a potential antiulcer agent, our attention was drawn to the cryopreserved placenta extract ("Cryocell-cryoextract placenta"). It eliminates the ulcerogenic effect of anti-inflammatory drugs of non-steroidal nature, without affecting their therapeutic efficacy.&#x0D; Objective: to characterize the anti-ulcerogenic effect of therapeutic and prophylactic use of cryopreserved placenta extract in the model of alcohol-prednisolone gastric lesions in rats.&#x0D; Methods. The study was performed on 28 male rats weighing 200-220 g. they were randomized into four groups: I (n = 7) – intact rats, II (n = 7) – control – rats with model pathology (alcohol-prednisolone gastric lesion) without treatment, III (n = 7) – rats with alcohol-prednisolone gastric lesions, which were injected with cryoextract placenta (0.16 ml / kg body weight, intramuscularly), IV (n = 7) – rats with alcohol-prednisolone gastric lesions, which were administered the reference drug esomeprazole, proton pump inhibitor (50 mg / kg , intragastric). Gastric lesions in rats were simulated by intragastric single administration of prednisolone (20 mg/kg) dissolved in 80.0% ethanol (0.6 ml/100 g body weight). Cryoextracts of the placenta were administered intravenously in a prophylactic mode – 1 time per day for 4 days before and 1 time 60 minutes after the introduction of ethanol-prednisolone mixture. In 24 h. after administration of the mixture, rats were removed from the experiment and the size of the stomach (bloating) and the presence of adhesions with adjacent organs were evaluated macroscopically by the following criteria: erosions and hemographies, hyperemia, edema and mucosal fold disorders. For each group, the percentage of experimental animals was calculated according to these characteristics and the average value of their severity. The values ​​of the ulcer index were calculated for each group.&#x0D; Results. The study showed that the introduction of placental cryoexact as well as the reference drug esomeprazole led to a statistically significant (p&lt;0.05) reduction of three times the prevalence of gastric ulcers in rats after administration of alcohol-prednisolone mixture. The use of placental cryoextract in the treatment-and-prophylactic regimen led to a statistically significant (p&lt;0.05) decrease in the value of the ulcer index in 13 times relative to the control rats, and the average score of macroscopic assessment of gastric mucosa was 3.5 times lower and was 1.1±0.24 and 3.9±0.26, respectively. In animals treated with esomeprazole 2 times more moderate (2 [0.5; 3] points) hyperemia of the central nervous system (57.1% and 28.6%, respectively) and several times more moderate (2 [0; 2]). points) edema of the secondary school. In addition, edema of the central nervous system in rats administered esomeprazole led to a clear (3 [2; 3] points) violation of the folding of the central nervous system in 71.4% of rats. In contrast to the use of esomeprazole, placental cryoextract more significantly leveled the hyperemia induced by the introduction of alcohol-prednisolone mixture and edema of the gastric mucosa, which were observed in only 28.6% and 14.3% of rats, respectively.&#x0D; Conclusions. Therapeutic and prophylactic use of placental cryoextract was accompanied by statistically significant (p &lt;0.05) comparable to esomeprazole antiulcer efficacy in the model of ethanol-prednisolone gastric lesion and amounted to 92.3%.

EE419 Cost-Effectiveness Analysis of Non-Invasive Screening in Patients with Diabetic Foot Ulcers

The prevalence of diabetic foot ulcers (DFU) is rising fast along with the prevalence of diabetes. As a well-known risk factor of lower extremity amputation, DFU are costly in pecuniary and non-pecuniary means. However, early screenings within low-risk DFU patients are not recommended in clinical guidelines. From a healthcare sector perspective, we sought to find the cost-effectiveness of non-invasive screening tests, ankle-brachial index (ABI) and transcutaneous oxygen measurement (TcPo2), for DFU patients to achieve better clinical outcomes.