Previous Ulcer Research Articles

Seronegative and Low Seropositive Treatment-Naive Secondary Syphilis in India: A Cross Sectional Study

Abstract The non-treponemal tests like VDRL and RPR hold an important place in the diagnosis of syphilis. In many countries, these tests are used for screening, with positive results being subsequently confirmed by treponemal or specific tests like TPHA or FTA-ABS. Recent observations of low-titer VDRL or RPR positivity (<1:8) or negative results in patients with clinically active syphilis are becoming a cause for concern especially in the backdrop of a resurgence of the disease. Such a scenario might undermine the usefulness of VDRL or RPR as effective screening test and for treatment monitoring. We studied the titers of non-treponemal serological test (VDRL) in non-HIV-positive, untreated cases of secondary syphilis (diagnosed clinically and confirmed serologically with specific treponemal tests like TPHA or FTA-ABS). It was an OPD-based cross-sectional study, which included patients presenting with muco-cutaneous lesions suggestive of secondary syphilis, confirmed serologically with positive specific treponemal tests, who were seronegative for HIV1 and 2 and had not received treatment with injectable benzathine penicillin. Their VDRL titers were noted. Information regarding duration of lesions and any previous genital ulcer was obtained, and additional information was sought regarding any medications taken during the last two months. Nineteen patients (12 males, 4 females, and 3 transgender individuals) between the ages of 18 and 46 years were included in the study. Ten of these cases (52.63%) had a VDRL titer of less than 1:8 (non-reactive in 5 patients, titer of 1:4 in 5 patients). Among the remaining nine cases, a titer of 1:8 was observed in six, 1: 16 in two, and 1:32 in one case. Our observations raise concerns regarding the possibility that a significant number of patients with active syphilis and potential to transmit the disease are being left untreated because of low or negative titers in the screening tests. This may account for the slow resurgence of syphilis as documented by increase in case rates and incidence of congenital syphilis in different parts of the world.

Protocolo de exploración del pie diabético

The diabetic foot screening protocol recommends an annual assessment in all patients with diabetes starting at the time of diagnosis in those with type 2 diabetes mellitus (DM2). The examination focuses on three aspects: a visual inspection of the foot, a vascular evaluation by means of pedal pulses, and neurological examination using a 10g monofilament to detect sensory loss. It is essential to identify risk factors for ulcers, such as neuropathy, deformities, and peripheral arterial disease (PAD). If there are signs of risk, such as previous ulcers or sensory loss, patients should be referred to a diabetic foot specialist. Tests such as the ankle-brachial index (ABI) are used for vascular assessment and other tools such as a monofilament and tuning fork are used to measure neurological sensitivity. The patient's risk classification is used to plan follow-up and treatment.

Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration.

Pressure-relieving footwear helps prevent foot ulcers in people with diabetes. The footwear design contributes to this effect and includes the insole top cover. We aimed to assess the offloading effect of materials commonly used as insole top cover. We measured 20 participants with diabetes and peripheral neuropathy for in-shoe peak pressures while walking in their prescribed footwear with the insole covered with eight different materials, tested in randomized order. Top covers were a 3 mm or 6 mm thick open or closed-cell foam or a 6 mm thick combination of open- and closed-cell foams. We re-assessed pressures after one month of using the top cover. Peak pressures were assessed per anatomical foot region and a region of interest (i.e., previous ulceration or high barefoot pressure). Walking comfort was assessed using a 10-point Likert scale. Mean peak pressure at the region of interest varied between 167 (SD:56) and 186 (SD:65) kPa across top covers (p < 0.001) and was significantly higher for the 3 mm thick PPT than for four of the seven 6 mm thick top covers. Across 6 mm thick top covers, only two showed a significant peak pressure difference between them. Over time, peak pressures changed non-significantly from -2.7 to +47.8 kPa across top cover conditions. Comfort ratings were 8.0 to 8.4 across top covers (p = 0.863). The 6 mm thick foams provided more pressure relief than the 3 mm thick foam during walking in high-risk people with diabetes. Between the 6 mm thick foams and over time, only small differences exist. The choice of which 6 mm thick insole top cover to use may be determined more by availability, durability, ease of use, costs, or hygienic properties than by superiority in pressure-relief capacity.

Impact of Poor Glycemic Control and Vascular Complications on Diabetic Foot Ulcer Recurrence

Background: Diabetes mellitus is a growing global health issue that leads to serious complications like diabetic foot ulcers (DFUs), which can worsen health and increase death rates in diabetic patients. In Sorong, Southwest Papua, Indonesia, the recurrence of DFUs is a major public health problem, affecting patients' well-being and adding significant healthcare costs. This study aimed to identify the factors that contribute to DFU recurrence in this region to help improve prevention and treatment strategies. Methods: A cross-sectional study was conducted in Sorong, Indonesia, including 53 diabetic patients with recurrent DFUs. Data were collected through structured interviews, physical examinations, and laboratory tests. Risk factors such as metabolic, vascular, behavioral, and demographic elements were analyzed. Statistical analysis, including univariate, bivariate, and multivariate techniques, was performed to identify independent predictors of DFU recurrence. Results: The study found that poor glycemic control, with a mean HbA1c of 8.3±1.4, and vascular complications, such as peripheral artery disease and neuropathy, were the most significant predictors of DFU recurrence. Behavioral factors like smoking and physical inactivity, along with longer diabetes duration and previous ulcer history, also showed a strong correlation with recurrence. Logistic regression identified HbA1c levels, peripheral artery disease, and smoking habits as independent predictors. Conclusion: This study determined the need for comprehensive care that focuses on controlling blood sugar levels, managing vascular issues, and promoting healthy behaviors to prevent diabetic foot ulcer recurrence in Sorong, Southwest Papua. Future efforts should target these risk factors to lower recurrence rates and improve patient health. More research is needed to find effective ways to prevent DFU recurrence in this population.

Rituximab retention rate in systemic sclerosis: a long term real-life multicenter study.

to report real-life data on rituximab retention-rate as indicator of safety and efficacy in a multicentric national cohort of systemic sclerosis patients. SSc patients treated with rituximab and followed for at least 36 months were included, clinically characterized, and longitudinally monitored. A competing risk analysis with sub-Hazard Ratio(sHR) definition was performed to explore the clinical variables linked to specific cause of rituximab discontinuation. One-hundred-fifty-two SSc-patients (mean age 47.3 ± 12.3 years; females 79.6%; diffuse disease 77.6%; anti-topoisomerase-I positivity 63.2%) were evaluated over a median(IQR) time of 3.3(1.7-5.0) years. The primary indication for rituximab were interstitial lung disease (ILD)(38.8%), worsening skin fibrosis(36.8%), and arthritis(13.8%); 138 patients(90.8%) received more than one rituximab course. The 5-years rituximab retention rate was 59.9%(44.6-64.7%). Clinical response was the most common reason for rituximab discontinuation[5.7(3.7-8.4) per 100 patient-year] and was associated with a shorter disease duration[sHR 0.8(0.7-0.9)], anti-topoisomerase-I negativity[sHR 0.4(0.2-0.9)], previous digital ulcers[sHR 2.6(1.1-6.2] and no history of arthritis[sHR 0.3 (0.1-0.8)]. Treatment failure was the second cause of rituximab discontinuation[3.7(2.2-6.0) per 100 patient-year] and was associated with anti-centromere antibody positivity[sHR 2.8(1.1-7.4)] and anti-topoisomerase-I negativity[sHR 0.2(0.1-0.6)]. Adverse events(AEs) were the less common cause of discontinuation[3.1(1.7-5.2) per 100 patient-year], associated with limited cutaneous subset[sHR 3.4(1.2-9.7)] and previous mycophenolate mofetil treatment[sHR 4.5(1.2-16.3)]. rituximab is a safe and effective treatment in SSc: clinical response emerged as the primary reason for rituximab discontinuation, and AEs had a limited impact on treatment persistence. The identification of specific disease features associated with a response to rituximab will be useful in the management of SSc-patients.

Using 16s rRNA sequencing to characterize the microbiome of tropical cutaneous ulcer disease: insights into the microbial landscape and implications for diagnosis and treatment.

Cutaneous ulcers are common in yaws-endemic areas. Although often attributed to 'Treponema pallidum subsp. pertenue' and Haemophilus ducreyi, quantitative PCR has highlighted a significant proportion of these ulcers are negative for both pathogens and are considered idiopathic. This is a retrospective analysis utilising existing 16S rRNA sequencing data from two independent yaws studies that took place in Ghana and the Solomon Islands. We characterized bacterial diversity in 38 samples to identify potential causative agents for idiopathic cutaneous ulcers. We identified a diverse bacterial profile, including Arcanobacterium haemolyticum, Campylobacter concisus, Corynebacterium diphtheriae, Staphylococcus spp. and Streptococcus pyogenes, consistent with findings from previous cutaneous ulcer microbiome studies. No single bacterial species was universally present across all samples. The most prevalent bacterium, Campylobacter ureolyticus, appeared in 42% of samples, suggesting a multifactorial aetiology for cutaneous ulcers in yaws-endemic areas. This study emphasizes the need for a nuanced understanding of potential causative agents. The findings prompt further exploration into the intricate microbial interactions contributing to idiopathic yaw-like ulcers, guiding future research toward comprehensive diagnostic and therapeutic strategies.

IJCM_121A: Assessment of risk of foot ulcer in patients with diabetes according to the risk classification consensus of International Working Group on Diabetic Foot (IWGDF) in Ernakulam District, Kerala; a community based cross sectional study

Background: The International Diabetes Federation states that India accounts for 1 in 7 of all adults living with diabetes worldwide. Diabetic foot disease is among the most serious complications of diabetes mellitus as it is a source of major suffering and financial burden for the patient, healthcare professionals and the society in general. The leading cause of lower-limb amputations is diabetes and 40%–85% of these are preventable Objective: Assessment of diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) consensus. Methodology: A community based cross-sectional study was done in Ernakulam district involving 600 individuals with diabetes mellitus. The study gathered information on sociodemographic factors, anthropometric details and a detailed foot examination was performed with a IWGDF checklist. The collected data were entered into MS Excel, and the analysis was carried out using SPSS 21.0. Results: Mean age of patients in the study was 61.48 yrs±10.24 years.371 patients (61.83%) were females and 229(38.17%) were males.108 patients (18%) had disturbed sense of vibration (128 Hz). 90 patients (15%) had decreased sensitivity to 10-gram monofilaments. Peripheral arterial disease was present in 47 patients (7.83). 20 patients (3.33%) had history of previous ulcer. 11(1.83%) patients had lower extremity amputation. Patients were classified into four risk groups according to IWGDF criteria. Four hundred and fifty-five patients (75.83%) were in group 0, fifty-five patients (9.1%) in group 1, sixty-six patients (11%) in group 2 and twenty-four patients (4%) in group 3 of IWGDF criteria Conclusion: Routine foot examination in patients with diabetes as per IWGDF guidelines for each risk category will help in prevention of diabetic foot ulcers.

Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial.

Patients with Child-Turcotte-Pugh class B and C cirrhosis with upper gastrointestinal bleeding (UGIB) have systemic as well as localized (in the mucosa of the esophagus and stomach) fibrinolysis. The aim of this study was to evaluate the efficacy and safety of tranexamic acid in the treatment of acute UGIB in patients with cirrhosis. A total of 600 patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB were randomly allocated to either the tranexamic acid (n=300) or the placebo group (n=300). The primary outcome measure was the proportion of patients developing 5-day treatment failure. Failure to control bleeding by day 5 was seen in 19/300 (6.3%) patients in the tranexamic acid group and 40/300 (13.3%) patients in the placebo group ( p =0.006). Esophageal endoscopic variceal ligation (EVL) site as a source of failure to control bleeding by day 5 among patients undergoing first-time esophageal EVL (excluding patients with a previous post-EVL ulcer as a source of bleed) was seen in 11/222 (4.9%) patients in the tranexamic acid group and 27/225 (1212.0%) patients in the placebo group ( p =0.005). However, 5-day and 6-week mortality was similar in the tranexamic acid and placebo groups. Tranexamic acid significantly reduces the failure to control bleeding by day 5 and failure to prevent rebleeding after day 5 to 6 weeks in patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB, by preventing bleeding from the EVL site.

Digital gangrene in systemic sclerosis patients: not only due to the microvascular disease.

This study aims to investigate the characteristics, risk factors, and outcomes of digital gangrenes in SSc patients, and to identify whether vasculitis is one of the causes for digital gangrene. A retrospective case-control study was performed from February 2003 to April 2021. Forty-three SSc patients with digital gangrene admitted to Peking Union Medical College Hospital were included. One-hundred forty-six age- and sex-matched SSc patients without gangrene were selected as controls during the same period. Univariate and multivariate logistic regression analysis was used to determine risk factors. Among 43 SSc patients with gangrene, 93.0% had Raynaud's phenomenon (RP) and 32.6% had current or previous digital ulcers (DU). SSc patients with digital gangrene had more ESR elevation (54.8% vs. 34.9%, p = 0.020) and higher level of high-sensitive C reactive protein (median 7.2mg/L vs. 1.8mg/L, p = 0.045) compared with controls. In the multivariable logistic regression analysis, smoking history (OR 4.119, p = 0.037), anti-centromere antibody positivity (OR 3.542, p = 0.016), anti-neutrophil cytoplasmic antibody positivity (OR 22.605, p = 0.037), and anti-phospholipid antibody positivity (OR 16.563, p = 0.001), as well as elevated ESR (OR 2.524, p = 0.038) were identified as independent risk factors for gangrenes. Most (79.1%) cases were treated with combination of immunosuppressive and vasodilating therapy, and four cases also got remised after treatment of only glucocorticoid and immunosuppressive agent. Smoking history; positive-ACA, ANCA, and anti-phospholipid antibodies; and increased ESR were independent risk factors for digital gangrenes in SSc. Vasculitis and macrovascular disease may contribute to the progression of digital gangrenes. Key Points •18.6% of SSc patients with digital gangrene had macrovascular stenosis. •Smoking, positive-ACA, ANCA, aPL, and increased ESR were indicators for digital gangrenes in SSc. •Vasculitis and macrovascular disease may involve in the pathogenesis.

The 10-year follow-up of a community-based cohort of people with diabetes: The incidence of foot ulceration and death.

Identifying people with diabetes who are likely to experience a foot ulcer is an important part of preventative care. Many cohort studies report predictive models for foot ulcerations and for people with diabetes, but reports of long-term outcomes are scarce. We aimed to develop a predictive model for foot ulceration in diabetes using a range of potential risk factors with a follow-up of 10 years after recruitment. A new foot ulceration was the outcome of interest and death was the secondary outcome of interest. A 10-year follow-up cohort study. 1193 people with a diagnosis of diabetes who took part in a study in 2006-2007 were invited to participate in a 10-year follow-up. We developed a prognostic model for the incidence of incident foot ulcerations using a survival analysis, Cox proportional hazards model. We also utilised survival analysis Kaplan-Meier curves, and relevant tests, to assess the association between the predictor variables for foot ulceration and death. At 10-year follow-up, 41% of the original study population had died and more than 18% had developed a foot ulcer. The predictive factors for foot ulceration were an inability to feel a 10 g monofilament or vibration from a tuning fork, previous foot ulceration and duration of diabetes. The prognostic model shows an increased risk of ulceration for those with previous history of foot ulcerations, insensitivity to a 10 g monofilament, a tuning fork and duration of diabetes. The incidence of foot ulceration at 10-year follow-up was 18%; however, the risk of death for this community-based population was far greater than the risk of foot ulceration.

Risk Factors for Ulcer Recurrence in Diabetic Patients Managed by an Integrated Foot Care Protocol.

The aim of our study was to identify risk factors for the recurrence of diabetic foot ulcers (DFUs) in a selected population of patients in secondary prevention treated, according to International Guidelines, with an integrated foot care protocol by a referral diabetic foot clinic. A retrospective study was performed with the inclusion of selected outpatients with diabetes at higher risk for ulceration with a history of previous ulcer and/or amputation followed in our diabetic foot clinic between January 2015 and December 2021. According to the presence or absence of recurrence, patients were divided into 2 groups: ulcer recurrence and without ulcer recurrence. One hundred twenty-seven (127) patients were included, 47 patients (37%) developed an ulcer recurrence while 80 patients (63%) did not. The mean age was 71.7 years; 65% were male; 97% were affected by type 2 diabetes with a mean duration of 21.1 years, the mean HbA1c was 63 + 21 mmol/mol. Both groups of patients had foot deformities, such as claw and hammertoes; hallux valgus, and prominent metatarsal heads (MTHs). The presence of deformity was significantly associated with ulceration. The group with ulcer recurrence showed a higher rate of prominence MTHs in comparison to a group without ulcer recurrence. The MTHs resulted as the only independent predictor for recurrence. This study shows that the presence of the prominent MTH is a significant risk factor for ulcer recurrence in a selected population of diabetic foot patients treated in the best way with integrated foot care.

Use of Bisphosphonates and the Risk of Skin Ulcer: A National Cohort Study Using Data from the French Health Care Claims Database.

Previous pre-clinical and pharmacovigilance disproportionality analyses highlighted a safety signal of cutaneous ulcer with bisphosphonate use. Therefore, our objective is to evaluate this risk and assess whether unmeasured confounding factors could explain this association. This study is a population-based cohort study from a representative sample (1/97th) of the French health insurance claims database: Echantillon Généraliste des Bénéficiaires (EGB) from 2006 to 2019. To limit the impact of our study design and methodological choices on any association between skin ulceration and exposure to bisphosphonates, we used several methods: a Cox proportional hazards analysis and a prior event rate ratio (PERR) analysis, using two propensity matched control groups, and either the first episode of incident ulceration or multiple event-time outcomes. There were 7402 individuals newly exposed to bisphosphonates matched to 29,605 unexposed individuals on propensity score. The primary outcome was skin ulcer occurrence assessed by at least 2 deliveries of wound dressing during the period of one month. Among 6911 individuals newly exposed to bisphosphonates and 28,072 unexposed individuals with no previous skin ulcer, the Cox regression yielded a hazard ratio (HR) of 1.40 (95% CI 1.26-1.56) for newly exposed individuals. Among 7402 exposed and 29,605 unexposed individuals, the PERR analysis found a non-significant HR of 1.03 (95% CI 0.87-1.24). Results were similar on the different sensitivity analyses. No association between bisphosphonate and skin ulcers was found in the French population. The association observed in previous pharmacovigilance studies and in the Cox regression analysis is likely due to unmeasured confounding factors.

Risk Factors for Ulceration in Diabetes Mellitus in the Preventive Foot Clinic at the Medical Center for Diabetes, Obesity, and Specialties, During the Period January-April 2022.

Introduction: Diabetes Mellitus is a conglomerate of metabolic alterations that chronically affect health. Neuropathy, previous ulcers, foot deformities, peripheral arterial disease, and chronic kidney disease are risk factors that predispose to the development of foot ulcers. It was carried out in order to determine risk factors for ulceration in people living with diabetes mellitus. Materials and methods: Descriptive observational study of 233 people who attended the Preventive Foot consultation at the Diabetes, Obesity and Specialties Medical Center, during the period January-April 2022. Information collected through a questionnaire that reported age, sex, marital status, time of diagnosis of diabetes mellitus, history of ulcer, amputation, bone deformity, chronic renal failure, neuropathy and peripheral arterial disease. Results: 60% female, 40% male, 60% ≥ 62 years. 39.6% with diagnosis time ≥16 years, 65.2%-foot deformity, 12.8% previous ulcer, 5.1% previous amputation, 10.3% chronic renal failure, 36% peripheral neuropathy and 31.3% peripheral arterial disease. 47.6% presented a very low risk, 27.5% moderate, 15% high risk and 9% low. Association time of diagnosis and neuropathy chi2= 8.993, p= &lt;0.029. Ulcer and amputation correlation rho=0.606, p=&lt; .001. Discussion: As risk factors predominated foot deformity, followed by diabetic neuropathy and peripheral arterial disease. With significant association between the time of diagnosis and neuropathy. With moderate direct proportional correlation between ulcer and previous amputation

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.

Outcomes of a multidisciplinary Diabetic Foot Day Unit

ObjectiveTo analyse the main characteristics of patients and the health outcomes obtained and to evaluate the impact of peripheral artery disease (PAD) in patients treated in our multidisciplinary Diabetic Foot Unit. Research design and methodsObservational prospective study. 273 patients from two different populations (with and without PAD – classified according to the presence of distal pulses) treated over a 14-month period in the multidisciplinary Diabetic Foot Unit were included. The data on patient characteristics and outcomes were analysed for the purpose of comparison. For the inference study, a comparison of medians with the non-parametric test for independent samples for the quantitative variables and a χ2 test for the comparison of proportions in qualitative variables were performed. ResultsPatients with PAD ulcers were older (60 (54–67) vs. 64 (75–81), p=0.000) and had a higher macrovascular burden (8.1% vs. 29% for ischaemic heart disease history, p=0.000; 6.7% vs. 18.1% for cerebrovascular disease history, p=0.004). Their Texas Score was higher (p=0.000) and their major amputation rate was higher (1.4% vs. 12.3%, p=0.001). They had less background of previous ulcers (52.6% vs. 26.8%, p=0.000), their episode duration was shorter (4 (0–10) vs. 0 (0–3) weeks, p=0.000), and their proportional need for antibiotic therapy was lower (64.4% vs. 51.4%, p=0.03). ConclusionsThe differences found between ulcers with and without vascular involvement support the need for a different approach and for the inclusion of vascular surgeons on the team. The multidisciplinary care model for diabetic foot patients could be effective and improve health outcomes.

Uso de PCR para detectar ADN de Leishmania en saliva de pacientes con leishmaniasis cutánea americana

Introduction: American cutaneous leishmaniasis (ACL) affects over one million people annually worldwide. Its spread enables Leishmania-parasites invading the skin, mucosa, and body-fluids including saliva. Detection of Leishmania-DNA in saliva, has been proposed as a non-invasive method. Objective: To evaluate the use of multiplex conventional PCR-assay in saliva to identify Leishmania-DNA from patients infected with ACL. Materials and Methods: Individuals with ACL were selected to evaluate a PCR-based saliva tool to identify Leishmania-DNA, 18 with active lesions and 3 with scars of previous healed ulcers, evaluated 2 years post-treatment. Saliva from 3 negative controls were included for comparison. Saliva samples (1 mL-each) were collected to be processed before, during and after treatment. Results: Amplification of Leishmania-DNA in saliva from patients with healed and active lesions, revealed Leishmania braziliensis in 78% pre-treated and 28% during and after the treatment. Conclusions: PCR-assay resulted useful identifying L. braziliensis in saliva from ACL-patients.

Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta-analysis.

A meta-analysis study was conducted to measure the consequence of diabetic foot ulcers (DFUs) and other risk factors (RFs) on the prevalence of lower extremity amputation (LEA). A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. Of the 32 chosen studies enclosed, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of DFUs and other RFs on the prevalence of LEA by the continuous and dichotomous approaches and a fixed or random effect model. Male gender (OR, 1.30; 95% CI, 1.17-1.44, P < .001), smoking (OR, 1.24; 95% CI, 1.01-1.53, P = .04), previous foot ulcer (OR, 2.69; 95% CI, 1.93-3.74, P < .001), osteomyelitis (OR, 3.87; 95% CI, 2.28-6.57, P < .001), gangrene (OR, 14.45; 95% CI, 7.03-29.72, P < .001), hypertension (OR, 1.17; 95% CI, 1.03-1.33, P = .01), and white blood cells count (WBCC) (MD, 2.05; 95% CI, 1.37-2.74, P < .001) were significantly shown to be an RF in LEA in subjects with DFUs. Age (MD, 0.81; 95% CI, -0.75 to 2.37, P = .31), body mass index (MD, -0.55; 95% CI, -1.15 to 0.05, P = .07), diabetes mellitus type (OR, 0.99; 95% CI, 0.63-1.56, P = .96), and glycated haemoglobin (MD, 0.33; 95% CI, -0.15 to 0.81, P = .17) were not shown to be an RF in LEA in subjects with DFUs. Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs. However, age and diabetes mellitus type were not shown to be RF in LEA in subjects with DFUs. However, caused of the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.

Analysis of risk factors for ulcer recurrence and upper gastrointestinal bleeding in children with peptic ulcer treated with Helicobacter pylori eradication therapy.

The incidence of peptic ulcer disease (PUD) has been increasing yearly, especially in the adolescent population. The eradication of Helicobacter pylori (H. pylori) may reduce recurrence and bleeding to some extent, but it does not completely change the clinical status of PUD. Therefore, this study aims to analyze the risk factors for ulcer recurrence and upper gastrointestinal bleeding after H. pylori eradication therapy in order to provide a reference for reducing the risk of PUD and improving the quality of life of patients. We retrospectively analyzed 536 adolescent patients who developed peptic ulcer and received H. pylori eradication therapy from June 2016 to July 2021. The relationship between the clinical characteristics of the patients and gastrointestinal bleeding and recurrence was analyzed using the t-test and chi-squared test. Binary logistic regression was used to analyze the independent risk factors for the occurrence of bleeding and recurrence. A total of 536 patients were included in this retrospective study. Gender, history of ulcers, number, size, location and staging of ulcers, and application of nonsteroidal anti-inflammatory drugs (NSAIDs), and other characteristics were significantly different between the bleeding and nonbleeding groups (P<0.05); family history of upper gastrointestinal ulcer, history of ulcers, number and size of ulcers and application of NSAIDs, and other characteristics were significantly different between the recurrent and nonrecurrent groups (P<0.05). Binary logistic regression analysis showed that history of ulcers, number and location of ulcers, coagulation abnormalities, and other characteristics were independent risk factors for the occurrence of bleeding; the occurrence of previous bleeding, number and size of ulcers, and other characteristics were independent risk factors for recurrence. In the clinical treatment of adolescent patients, it is important to pay high attention to clinical characteristics, such as the patient's previous ulcer history, the size, number and location of ulcers, and coagulation function, so as to adopt individualized treatment methods to effectively reduce the harmfulness of the disease in response to the risk factors of ulcer bleeding and recurrence after H. pylori eradication therapy. This can decrease the occurrence of complications and improve the prognosis of patients.

Vernal keratoconjunctivitis in Down syndrome: a case report

BackgroundDown syndrome (DS) or Trisomy 21 is the most common chromosomal disease and is characterized by possible heart defects, cognitive impairment and visual disorders.Case presentationWe describe for the first time a 17-year-old Caucasian girl suffering from Down syndrome associated with vernal keratoconjunctivitis (VKC), a rare disorder of the anterior segment of the eye, characterized by intense photophobia, redness, watering eyes and itching due to an inflammatory-allergic reaction of the cornea and conjunctiva. On slit-lamp examination, the girl showed conjunctival hyperemia, papillary hypertrophy, giant papillae and corneal leukoma in right eye as a result of a previous corneal ulcer. A successful topical immunosuppressant therapy with cyclosporin 1% was started.ConclusionSo far, to our knowledge, this is the first description of VKC in a patient with DS. Finding an inflammatory-allergic disease such as VKC in DS is unusual but it must be taken into account because keratoconus, one of the most frequent eye pathologies in DS, can be secondary to an unrecognized VKC.

Prognostic factors for delayed healing of complex wounds in adults: A scoping review.

Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.