Ulcer Research Articles

A chitosan-modified tea tree oil self-nanoemulsion improves antibacterial effects in vivo and in vitro and promotes wound healing by influencing metabolic processes against multidrug-resistant bacterial infections

Infectious diseases, especially multidrug-resistant bacterial infections, have caused crises and majorly disrupted public health and economic stability worldwide. Many natural essential oils, especially tea tree oil, have potential to treat multidrug-resistant bacteria, such as H. pylori and P. aeruginosa. However, there are some problems need to be solved, such as poor stability upon light or oxygen exposure. Therefore, it is urgent to develop the ideal formation to tackle these difficulties. Herein, we reported the novel chitosan-modified self-nanoemulsion (TNE) encapsulating natural essential tea tree oil with strong antibacterial and stability characterize. In this study, we found that this self-nanoemulsion (size: 212 nm, PDI: 0.124, zeta potential: −20.5 mV, 6 % tea tree oil) not only had physical properties, good stability and tissue safety, but also had better antibacterial synergism (2–8 times) than that of water suspension against various multidrug-resistant bacterial (such as H. pylori, MRSA and P. aeruginosa). Additionally, TNE showed high antibacterial effectiveness in vivo, reduced inflammation, promoted ulcer healing after H. pylori infection and accelerated wound healing after P. aeruginosa infection. Importantly, this novel self-nanoemulsion can induce 274 protein down-regulated and 251 protein up-regulated, and disrupt H. pylori metabolic processes (glyoxylate, dicarboxylic acid, glutamate and tryptophan metabolism) and reduced its viability, leading to significant synergistic antibacterial effects. TNE is a potential treatment for skin wounds or ulcers caused by multidrug-resistant bacterial infections.

Analysis of registered clinical trials in Italy regarding dermatology (2003-2022): a cross-sectional study on historical trend and prospects for industry investments.

This cross-sectional analysis intends to evaluate trend and outlook of industry clinical research in Italy regarding dermatology and its prospects for the next few years. A computerized search of ClinicalTrial.gov database was carried out considering the 20-year period 2003-2022 using the following string: "Skin Diseases OR Skin cancer OR Skin Neoplasms OR Skin Infection OR Skin Lesion OR Skin Ulcer OR Skin Laxity OR Skin toxicity OR Dermatologic Complication OR Skin abnormalities". During the last 20 years 690 Industry Clinical Trials (IndCTs) were conducted in Italy regarding dermatological investigations, almost entirely funded by non-Italian pharmaceutical companies, involving 4497 centers, and recruiting an average of 13.0 subjects per site. The number of controlled and randomized studies has grown quite regularly and in the last 5 years they represented 79.6% of IndCTs initiated. Countries most frequently sharing with Italy international protocols were Spain (75.0%), Germany (71.8%), France (68.5%), the USA (67.4%), and the UK (54.8%). These data point to a historical involvement of Italy in dermatology IndCTs lower than in the major European countries. However, the war in Ukraine has deprived IndCTs of the contribution of Russia, Ukraine, and Belarus, meaning a mean of about 40 new IndCTs per year in a population of 200 million inhabitants. In contrast, many indicators point to Italy as a country with potential in dermatology wider than used in the past: an efficient health care system accessible to any citizen or resident, 4.6 million dermatological interventions per year, low density of IndCTs concerning dermatology, good production of scientific papers in indexed medical journals, relatively low cost of services and labour and geopolitical stability. The European Clinical Trials Information System's (CTIS), mandatory for the EU member states since early 2023 allows common, simplified, and harmonized regulatory procedures over the life cycle of clinical trials in Europe (EMA, 2023) and plays in favor of Italy's greater competitiveness in clinical research.

Genetic Determinants of Clarithromycin and Fluoroquinolones Resistance in Helicobacter pylori in Serbia.

Stomach infections by Helicobacter pylori can cause acute or chronic gastritis, peptic ulcers, and gastric cancer. The rise in antibiotic resistance is a significant health issue highlighted by the World Health Organization. The increasing number of treatment failures underscores the necessity for antibiotic susceptibility testing (AST). The study aimed to investigate the current prevalence and resistance to fluoroquinolones and clarithromycin with their detected mutations. Stomach biopsies from symptomatic patients were subjected to molecular testing by GenoType Helico DR kit (Hain Lifescience GmbH, Nehren, Germany). Positive findings on the presence of H. pylori were detected in 42.4% of symptomatic patients, with the significant majority of patients (69%) having previously failed treatments. The resistance rates to fluoroquinolones and clarithromycin were 53.9% and 58.5%, respectively, with significantly higher rates in secondary resistant strains. The main resistance markers in fluoroquinolones and clarithromycin were N87K (27.4%) and A2147G (78.6%), respectively. Hetero-resistance or mixed genotypes were detected in over 20% of tested patients. During the study period, a significant increase in trends in both fluoroquinolones and clarithromycin resistance rates was observed. Results indicate the need for the implementation of the latest Maastricht VI Consensus recommendations for both AST whenever possible and the use of tailored guided therapy options due to high resistance rates and possible treatment failures. The GenoType Helico DR kit is a useful tool for AST, especially in cases of mixed H. pylori genotypes.

Effectiveness of autologous leucocyte and platelet-rich fibrin (L-PRF) in management of chronic diabetic foot ulcers.

Effectiveness of autologous leucocyte and platelet-rich fibrin (L-PRF) in management of chronic diabetic foot ulcers.

Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study

BackgroundThis study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM). MethodsWe audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006–2020) within the International Network for Sharing Practices of ECT (InspECT). Results452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had ≤10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1–8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years. ConclusionsAmong patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.

Healing Effect of Topically Applied Nano-Curcumin on Buccal Traumatic Ulcer in Albino Rats (Histological and Immunohistochemical study)

Healing Effect of Topically Applied Nano-Curcumin on Buccal Traumatic Ulcer in Albino Rats (Histological and Immunohistochemical study)

Clinical and Histological Efficacy of Nanofat Grafting in the Healing Process of Chronic Ulcers

Clinical and Histological Efficacy of Nanofat Grafting in the Healing Process of Chronic Ulcers

Biochemical and Molecular Detection of Aeromonas Hydrophila Isolated from Infected Cyprinus Carpio in Salah Al-Din Governorate

This study aimed to identify the presence of Aeromonas hydrophila bacteria in diseased common carp (Cyprinus carpio) fish collected from Salah al-Din Governorate in Iraq. For this purpose, 128 swabs were obtained from skin, gill and fin lesions of 70 fish showing symptoms of hemorrhagic sepsis, skin ulcers and boils, and fin and gill rot. Through different biochemical tests, the isolates showed negative results for Gram stain, methyl red, lactose fermentation, H2S, and string test, while positive results were recorded for glucose fermentation, oxidase, motility test, catalase, Voges-Proskauer, indole, citrate utilization, and gelatin hydrolysis. Eleven isolates were confirmed as A. hydrophila by amplification of the hemolysin gene fragment (hlyA) by conventional PCR. This study represents the first comprehensive study to characterize A. hydrophila bacteria from infected common carp fish in Salah al-Din Governorate. The findings of this study provide valuable insights for developing genetic diagnostic strategies for A. hydrophila infections in this region.

Traumatic ulcer in patient with obsessive-compulsive disorder: a case report

Traumatic ulcer in patient with obsessive-compulsive disorder: a case report

Opportunities for Helicobacter pylori Eradication beyond Conventional Antibiotics.

Helicobacter pylori (H. pylori) is a bacterium known to be associated with a significant risk of gastric cancer in addition to chronic gastritis, peptic ulcer, and MALT lymphoma. Although only a small percentage of patients infected with H. pylori develop gastric cancer, Gastric cancer causes more than 750,000 deaths worldwide, with 90% of cases being caused by H. pylori. The eradication of this bacterium rests on multiple drug regimens as guided by various consensus. However, the efficacy of empirical therapy is decreasing due to antimicrobial resistance. In addition, biofilm formation complicates eradication. As the search for new antibiotics lags behind the bacterium's ability to mutate, studies have been directed toward finding new anti-H. pylori agents while also optimizing current drug functions. Targeting biofilm, repurposing outer membrane vesicles that were initially a virulence factor of the bacteria, phage therapy, probiotics, and the construction of nanoparticles might be able to complement or even be alternatives for H. pylori treatment. This review aims to present reports on various compounds, either new or combined with current antibiotics, and their pathways to counteract H. pylori resistance.

MOF-Encapsulated Copper-Doped Carbon Dots Nanozymes with Excellent Biological Activity Promote Diabetes Wound Healing

Abstract Poor wound healing in diabetics is primarily caused by persistently high levels of inflammation and recurrent bacterial infections. The catalytic therapy technique based on nanozyme medicine has emerged as a beacon of hope for patients with diabetic wounds. However, the use of a single-atom nanozyme may still have limitations, including nanozyme burst release, immunological clearance, and insufficient antibacterial activity. To address the aforementioned problems, we provide a new nano-catalytic therapeutic agent for diabetic skin ulcers that incorporates a single-atom nanozyme with high antioxidant activity into a metal-organic framework (ZIF-Cu/C-dots). First, a Cu single-atom nanozyme supported by ultra-small carbon dots (Cu/C-dots) with high antioxidant activity was created. A nanozyme-integrated metal-organic framework was then created, utilizing Cu/C-dots as ligands and Zn2+ as the core metal. Cu/C-dots have good oxidase-like activity, shielding the biological system from ROS damage and reducing the expression of TNF-α and IL-1β. Zn2+ also has good antibacterial activity (the antibacterial rate was more than 90%). This integrated technique prevents nanozyme aggregation, improves nanozyme biocompatibility, slows down the breakdown of ZIF, and allows for the regulated release of Cu/C-dots and Zn2+ as needed. Finally, in vivo studies have shown that ZIF-Cu/C-dots can effectively alleviate inflammation at the site of diabetic wounds, accelerate vascular regeneration, promote collagen deposition, and enhance tissue remodeling, serving as a novel nano-catalytic platform for the treatment of wounds that are difficult to heal.

Ulcer Node Syndrome

The association of a skin ulcer (lesion) with regional or distant lymphadenopathy (LAD) has been termed ulcer (U)/node (N) syndrome. The existence of both adenopathy and ulcerative lesions in a patient can narrow diagnostic possibilities. Appropriate blood and microbiologic exams help confirm the diagnosis. This syndrome is further classified in one of four categories: 1. Predominant lymphadenopathy (N greater than U) 2. Lymphadenopathy only 3. Predominant ulcerative (U greater than N) 4. Ulcer only

Healing of Recalcitrant Chronic Ulcers by Hair Follicle-Containing Punch Grafts in Epidermolysis Bullosa.

Healing of Recalcitrant Chronic Ulcers by Hair Follicle-Containing Punch Grafts in Epidermolysis Bullosa.

Argon plasma photocoagulation for prevention of chronic ulcers and bleeding in solitary rectal ulcer syndrome: Scoping review and narrative summary

Argon plasma photocoagulation for prevention of chronic ulcers and bleeding in solitary rectal ulcer syndrome: Scoping review and narrative summary

Adherencia al Tratamiento Inmunosupresor en Pacientes Trasplantados Renales en una Institución de Salud de la Ciudad de Corrientes, entre 2018-2023.

Objective: This research aimed to describe adherence to immunosuppressive treatment in kidney transplant patients.Material and methods: Quantitative, descriptive, cross-sectional and observational study. Population: Kidney transplant recipients assisted in a health institution in the city of Corrientes, in the period from March 2018 to March 2023. A questionnaire was used based on 2 measurement scales, ITAS and ITBS. The information collected was analyzed using an Excel computer program. 23 kidney transplant patients were surveyed.Results: 92% adhered to immunosuppressive treatment, the average age was 43 years and 57% were female. With respect to the variable that evaluates uncontrollable barriers to adherence to immunosuppressive treatment in the last three months, it is relevant to highlight that 87% of the participants report a decrease in these barriers, and in relation to the variable on controllable barriers that perceived by patients to adhere to immunosuppressive treatment in the last 3 months, it was observed that 100% of those surveyed have a lower presence of controllable barriers. Finally, adherence to immunosuppressive treatment according to age and sex. Conclusion: High adherence to immunosuppressive treatment in kidney transplantation is highlighted, 92% of participants. Improvement in uncontrollable barriers suggests positive progress in treatment management. Although there are divergences with other studies, the minimal perception of controllable barriers indicates a general commitment of patientsConclusions: Platelet-rich plasma is an effective and safe method to accelerate healing, reduce the area of ulcers and reduce pain in patients. Furthermore, this therapy does not increase bacteriological growth or microbial load in chronic venous ulcers.

The Challenges of Treating a Helicobacter pylori Infection following the COVID-19 Pandemic in Croatia: A Review.

Background:Helicobacter pylori (H. pylori) is a prevalent bacterial pathogen implicated in different stomach and duodenal diseases, including chronic gastritis, gastric and duodenal ulcer, and stomach cancer. The COVID-19 pandemic has significantly influenced antibiotic prescription practices, potentially exacerbating antibiotic resistance in H. pylori. Objective: This study aims to investigate antibiotic prescription during the COVID-19 pandemic in Croatia and its possible impact on H. pylori antibiotic resistance, with a focus on Croatia. Methods: An extensive literature search was conducted to identify relevant studies from March 2020 to June 2024. The search strategy included terms related to COVID-19, antibiotic prescription, and Croatia. Studies were selected based on predefined eligibility criteria, focusing on observational research addressing antibiotic use during the pandemic. Results: The COVID-19 pandemic has led to significant fluctuations in community antibiotic consumption within the European Union/European Economic Area. In Croatia, antibiotic use in 2022 surpassed 2019 levels, driven by increased consumption of macrolides and other antibiotics. This surge, influenced by early pandemic treatment claims and penicillin shortages, contributed to rising antibiotic resistance in H. pylori. Resistance rates to clarithromycin and levofloxacin were notably high, driven by mutations in the 23S rRNA, gyrA, and gyrB genes. Discussion: The increased antibiotic use during the COVID-19 pandemic has highly likely complicated H. pylori eradication efforts, highlighting the necessity of judicious antibiotic use and robust antimicrobial stewardship. The pandemic underscored the need for new therapeutic strategies, optimized eradication regimens, and advanced diagnostic methods to manage bacterial infections effectively. Conclusions: The COVID-19 pandemic has significantly affected antibiotic use and resistance patterns, posing new challenges for H. pylori eradication. Addressing these challenges requires a multifaceted approach, including the development of new drugs and advanced diagnostics, coupled with sustained efforts in antimicrobial stewardship to combat emerging resistance threats.

Eficacia del plasma rico en plaquetas sobre las úlceras venosas. Revisión sistemática

Introduction: Venous ulcers are painful open sores that are difficult to heal. Treatment can be challenging, depending on the complexity of the wound, and may require the use of several therapies. Recently, the use of platelet-rich plasma in these patients has been suggested as a novel treatment. The objective of this work is to carry out a review on the effectiveness of platelet-rich plasma in venous ulcers. Method: A review was carried out following the PRISMA regulations. The databases of PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS were consulted. The Cochrane tool was used to assess the risk of bias. Results: Platelet-rich plasma is effective in venous ulcers. The total sample was 311 patients from seven clinical trials. The duration of therapy ranges from 6 to 24 weeks. All studies showed safety, tolerability and no major side effects. Conclusions: Platelet-rich plasma is an effective and safe method to accelerate healing, reduce the area of ulcers and reduce pain in patients. Furthermore, this therapy does not increase bacteriological growth or microbial load in chronic venous ulcers.

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers. Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks. Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects. Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Sukralfat as a Therapy for Reducing Itching and Repairing the Skin Barrier: A Systematic Review

Sucralate is an aluminum salt from sucrose octasulfate that is known for its anti-ulcer activity, mucosal protection, and anti-mucositis potential. Recently, sucralfat has been used topically for the healing of various epithelial wounds, including ulcers, inflammatory dermatitis, mucositis, and burns. This systematic review aimed to evaluate the effectiveness of sucralfat as a topical therapy in reducing itching (pruritus) and improving the skin barrier. The analysis method used is Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). A literature search was conducted on studies from 2004 to 2024 using keywords such as "sucralfate", "pruritus", "dermatitis", and "skin barrier" on PubMed, ProQuest, Science Direct, and Scopus databases. Inclusion criteria include topic relevance, research design, human subjects, and United Kingdom-speaking studies. Of the 141 articles found, 7 articles met the inclusion criteria. These studies involved a total of 605 subjects from different countries and used clinical trial methods and randomized controlled trials. The results showed that topical sucralfat was effective in reducing itching and improving the skin barrier in various skin conditions such as diaper dermatitis, chronic ulcers, and postoperative wounds. Sukralfat shows great potential in wound healing and skin barrier repair through the mechanism of protective layer formation, increased expression of epidermal growth factors, and anti-inflammatory properties. This effect indirectly helps reduce pruritus which often occurs due to damage to the skin barrier. Topical succulthate is effective in reducing itching and repairing the skin barrier, making it a promising therapy for a variety of inflammatory and ulcerative skin conditions.

Volatile organic compound detection of Buruli ulcer disease: Headspace analysis of Mycobacterium ulcerans and used gauzes of Buruli-compatible ulcers.

Diagnosing Buruli ulcer (BU) is complicated by limited access to the sensitive IS2404 qPCR. Experienced clinicians report a distinct odour of Buruli ulcers. We explored the potential of headspace analysis by thermal desorption-gas chromatography-mass spectrometry to detect volatile organic compounds (VOCs) from Mycobacterium ulcerans both in vitro and clinically. This study was conducted in two phases: a discovery and validation phase. During the discovery phase, VOCs that enable identification of M. ulcerans cultures were determined. During the validation phase, these VOCs were evaluated in clinical samples for which we used gauzes from patients with skin ulcerations in the Democratic Republic of Congo. Seven M. ulcerans headspace samples were compared with four from sterile growth medium and laboratory environmental air. The univariate analysis resulted in the selection of 24 retained VOC fragments and a perfect differentiation between cultures and controls. Sixteen of 24 fragments were identified, resulting in eleven unique compounds, mainly alkanes. Methylcyclohexane was the best performing compound. Based on these 24 fragments, headspace samples originating from gauzes of 50 open skin lesions (12 qPCR positive and 38 negative) were analysed and an AUC of 0.740 (95%-CI 0.583-0.897) was obtained. As this is an experimental study, future research has to confirm whether the identified compounds can serve as novel biomarkers.