Ulcer Stage Research Articles

Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: Case Report

CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5-C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers.

Experimental Modeling of the Ultra-Necrotic Stage of Critical Ischemia 
 of the Lower Limbs

Objective. So far, no experimental model of the necrotic ulcerative stage of critical limb ischemia has been created. Aim. Development of a method for modeling the necrotic ulcerative stage of critical lower limb ischemia.Materials and methods. The experimental study was carried out on 120 rats - males of the "Wistar" line, divided into 4 groups of 30 animals each. In the first group (intact), the level of microcirculation in the muscles of the hind limb was determined. In the second (sham-operated) group, ischemia was not simulated, but the neurovascular bundle of the thigh was isolated and the wound was sutured. In the third group (comparison), the modeling of chronic ischemia of the leg muscles was performed by removing the femoral, popliteal, anterior and posterior tibial arteries. In the fourth (experimental) group, to simulate chronic critical ischemia of the leg muscles, the femoral, popliteal, anterior and posterior tibial arteries and veins were removed, and the peripheral nerve was damaged.In the postoperative period, the dynamics of symptoms of limb ischemia was monitored. Animals were taken out of the experiment, 10 animals in each group by an overdose of anesthesia on the 10th, 21st and 28th days. Before hatching, the level of microcirculation was determined using laser Doppler flowmetry. To study the morphological picture at the same time in the third and fourth groups, the ischemic gastrocnemius muscle of the leg was excised and a standard histological examination was performed.Results. Trophic disorders in animals of the third group developed in 13.3%, and in the experimental group - in 100%. In the experimental group, the level of microcirculation at all periods was significantly less than in the comparison group: on the 10th and 21st by 1.3 times, on the 28th day by 1.2 times, and the area of ​​muscle necrosis was greater by the same days by 21.2%, by 8.2% and by 6.8%.Conclusion. The developed experimental model corresponds to the necrotic ulcerative stage of critical ischemia in humans.

Charcot Arthropathy of Foot and Ankle: Radiographic and Clinical Patterns with Related Outcomes.

Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle. Two hundred twenty-eight patients (235 feet) with post-acute Charcot were reviewed and classified anatomically through plain radiographs into type I and type II based on single or multiple regions affected, respectively. Type I included ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint, or calcaneus. Type II included peritalar, perinavicular, mid-tarsal Charcot, or any other combination. Both types were further classified into four stages (A, stable with no deformity; B, stable with deformity; C, unstable; and D, deformity/instability with associated mechanical ulcers). The most common type was type IIC (27.2%) followed by type IID (18.3%), while types IA and IIA represented the least common types (3.4% and 3.8%, respectively). Types IA and IIA were managed conservatively. All patients in types IC, ID, IIB, IIC, and IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Type II D had the highest complication rate (30%). Five patients ended up with amputation, and all were stage IID. Affection of single region has better prognosis than affection of two or more regions. Stage A has the best prognosis and can be managed conservatively provided good diabetes control. Surgery is indicated in all cases of types IC, ID, IIB, IIC, and IID to achieve stability and correction of deformity and prevent complications. Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate.

Aftermarket effects of cenegermin for neurotrophic keratopathy in pediatric patients

PurposeNeurotrophic keratopathy (NK) is a rare condition characterized by poor corneal sensation and healing. Cenegermin (topical recombinant nerve growth factor) has gained traction as a medical therapy for NK in recent years, and is FDA-approved for patients over two years old. However, no major trials have demonstrated the drug's efficacy in children. This study reviews the outcomes of cenegermin therapy in a pediatric patient population. MethodsRetrospective case series of patients from three tertiary referral institutions who 1) initiated an 8-week course of cenegermin therapy, and 2) were 18 years or less at time of treatment initiation. ResultsEight pediatric patients, with a total of nine affected eyes, underwent cenegermin therapy. All eight patients had previously trialed other NK-specific treatments, none of which had been entirely successful. Five patients (63%) completed the full eight-week therapy course. Five patients (63%) experienced clinical improvement not attributed to another treatment, through improved corneal ulcer stage (n = 5) and best-corrected visual acuity (n = 2). Clinical improvements persisted through a mean recurrence-free period of 10 months. Adverse effects reported during therapy included ocular pain, difficulty sleeping, and continued corneal thinning. ConclusionThe results provide modest support for the use of cenegermin in pediatric patients with neurotrophic keratopathy. The primary benefit was an improvement in corneal epithelial stability. Clinicians should be aware that pre-existing corneal scarring in NK may significantly limit the ability of cenegermin alone to improve visual acuity, and should closely monitor the corneal epithelial status during therapy in pediatric patients.

Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer

Introduction: In this study, we aimed to determine the demographic and clinical characteristics of patients with pressure ulcers who received home health care in Kutahya city and to investigate the relationship between the factors related to nutrition and pressure ulcer grades. Methods: This study is designed as a retrospective and cross-sectional. The files of 500 patients who were registered at home health services unit of Kutahya Health Sciences University Training and Research Hospital between December 2016 and May 2017 were reviewed retrospectively. Of these, sixty-three patients with pressure ulcers were included in the study. Results: In this study, 26 (41.3%) were male and 37 (58.7%) were female. The mean age of the patients with pressure ulcers was 74.41 ± 12.30 (years). 36 patients (57.1%) had cerebrovascular disease, 5 patients (7.9%) had dementia, 9 patients (14.3%) had malignancy, 8 patients (12.7%) had osteoarthritis, 4 patients 6.3%) had peripheral vascular disease, and 1 patient (1.6%) had previous traffic accident. The majority (62.1%) were neurological disease-sequenced and nursing-care group. When all the patients were examined, the region with the most pressure was the sacrum (35.3%). Hemoglobin level was found to be related to pressure ulcer grade (One-way ANOVA, p = 0.019). There was no significant relationship between other nutrition-related parameters and pressure ulcer stage. Conclusion: Patients with cerebrovascular disease constitute a significant proportion of patients receiving home care services. Low hemoglobin increases the severity of the pressure ulcer. Therefore, determining risk factors that contribute to pressure ulcer formation and efforts to prevent them should be the primary target of the home health care unit.

Relationships Between Oral-Mucosal Pressure Ulcers, Mechanical Conditions, and Individual Susceptibility in Intubated Patients Under Intensive Care: A PCR-Based Observational Study.

This study was performed to determine the relationship between oral-mucosal pressure ulcer (PU) stage and mechanical conditions and individual susceptibility in intubated patients. We collected 80 patient-days data from an intensive care unit of a 700-bed hospital in Korea. We analyzed oral-mucosal PUs, medical records, amount of saliva, and oral mucosal swabs. Bacterial abundance was enumerated by real-time polymerase chain reaction. The χ2 or Fisher's exact test, t-test or Mann-Whitney U test, and Spearman's rho correlation analysis were performed. The incidence of overall oral-mucosal PUs was 31.3%, and in the maxillary and mandibular sites were 16.3% and 26.3%, respectively. There were significant correlations between the maxillary site PU stage and restraint use (r = .43, p < .001), albumin level (r = -.22, p = .046), and relative abundance of P. aeruginosa (r = .45, p < .001) and S. aureus (r = -.24, p = .033). In the mandibular sites, there were significant correlations between PU stage and restraint use (r = .30, p = .008), level of consciousness (r = .31, p = .005), and relative abundance of P. aeruginosa (r = .25, p = .028) and S. pneumoniae (r = .22, p = .046). Frequent monitoring and repositioning the mechanical pressure on the oral-mucosa could be an effective preventive strategy against the development and advancement of oral-mucosal PUs. Additionally, monitoring the oral microorganisms can prevent advanced stage oral-mucosal PUs in intubated patients.

The effect of PPIs Alone, PPIs plus cytoprotective agent, and H2RA plus cytoprotective agent on ulcer healing after endoscopic submucosal dissection: A prospective randomized controlled trial

Background and Study AimsEndoscopic submucosal dissection (ESD) is the most effective treatment for early gastric cancer or gastric adenoma. However, ESD results in iatrogenic ulcers and postoperative bleeding from ulcers. This study aimed to evaluate the effect of using a proton pump inhibitor (PPI) alone, a PPI + rebamipide combination therapy, and an H2 receptor antagonist (H2RA) + rebamipide combination therapy on ulcer healing after ESD. Patients and MethodsA total of 204 patients who underwent ESD from April 2014 to July 2017 at Dong-A University Hospital were randomly assigned to the following groups: PPI-alone group, PPI + rebamipide combination therapy group, and H2RA + rebamipide combination therapy group. However, only 156 patients were studied since we excluded those who were lost to follow-up or had diseases other than early gastric cancer or gastric adenoma. Twenty-eight days after ESD, we evaluated the ulcer residual ratio, S stage rates, ulcer bleeding ratio, and gastric pH. ResultsThis study included 156 patients (PPI-alone group: 52 patients; PPI + rebamipide group: 52 patients; H2RA + rebamipide group: 52 patients). The ulcer residual ratios were 24.3 ± 14.2%, 17.0 ± 12.1%, and 21.0 ± 13.8% in the PPI alone, PPI + rebamipide, and H2RA + rebamipide groups, respectively (P = 0.048). ConclusionsPPI + rebamipide was more effective in reducing the ulcer residual ratio after ESD. There was no statistical difference in ulcer stage and delayed bleeding after ESD among the groups. These findings showed that PPI + rebamipide had limited benefits after ESD.

Crohn disease: magnetic resonance enterocolonography features of endoscopic ulcer stages reclassified with the healing process and the relationships to prognoses.

This study aimed to compare magnetic resonance enterocolonography (MREC) features among the endoscopic ulcer stages reclassified to include healing ulcers and to assess the prognoses in Crohn disease (CD). Altogether, 89 consecutive patients with CD who had undergone MREC and ileocolonoscopy or balloon-assisted enteroscopy were retrospectively studied. Patients were reclassified into 38 patients with no deep ulcer, seven with healing deep ulcer, and 44 with active deep ulcer stage. MREC score derived from a 5-point MR classification and MR index of activity (MaRIA) were evaluated, and patients were followed-up. The primary endpoint was hospitalization. Healing deep ulcers had higher values in MREC score and MaRIA than no deep ulcers (p < 0.001), and lower values than active deep ulcers (p < 0.001). The 5-year cumulative rates of hospitalization for no deep ulcer, healing deep ulcer, and active deep ulcers were 24.9, 0, and 52.4% (p < 0.05), respectively. MREC score or MaRIA-positive patients had a higher 5-year cumulative rate of hospitalization than the negative patients (p < 0.01 and p < 0.05, respectively). MREC could reflect the healing stages, and the identification was revealed to be important because of the good prognosis. MREC might be useful to predict prognosis of CD.

Evaluation of the combination of a biofilm-disrupting agent and negative pressure wound therapy: a case series

Approximately three million people in the US have hard-to-heal pressure ulcers (PUs), including 10% of hospitalised patients. Healing depends on ulcer stage and patient comorbidities. Despite advances in nutrition and wound care, PUs can take months or years to reach complete closure. To date, clinical studies have focused on single modality therapy. However, there is no one therapy that can address all of the deficits in these complex, hard-to-heal wounds. A commonly used treatment for PUs, negative pressure wound therapy (NPWT), has demonstrated improved healing in Stage 3 and 4 PUs. NPWT entails applying suction to a porous sponge fitted into the wound cavity and sealed with an occlusive dressing. Negative pressure facilitates wound healing by removing wound fluid containing harmful proteases, stimulating the formation of granulation tissue and promoting wound contracture. However, it does not affect biofilm formation. We hypothesised that adding an antibiofilm agent might increase the effectiveness of NPWT in recalcitrant PUs. A prospective case series was conducted in outpatient wound care centres and a skilled nursing facility to examine the combination of a biofilm-disrupting antimicrobial agent (Blast-X, Next Science, US) in combination with NPWT (VAC, 3M, US) in healing and reducing bacterial burden in treatment-resistant pressure ulcers. Patients consented to application of the antibiofilm agent and NPWT three times per week for four weeks. The wounds were measured, imaged for bacteria and tested for host and bacterial protease activity weekly. Of the 10 patients, four dropped out of the study before the end of the four weeks. Of the remaining six, four patients experienced a reduction in wound surface area and volume, reduced protease activity and lower bacterial levels. The results of this study showed that multimodal therapy, including NPWT and biofilm disruption, may restart the healing of stagnant treatment-resistant PUs.

Use of Machine Learning Approaches in Clinical Epidemiological Research of Diabetes

Machine learning approaches-which seek to predict outcomes or classify patient features by recognizing patterns in large datasets-are increasingly applied to clinical epidemiology research on diabetes. Given its novelty and emergence in fields outside of biomedical research, machine learning terminology, techniques, and research findings may be unfamiliar to diabetes researchers. Our aim was to present the use of machine learning approaches in an approachable way, drawing from clinical epidemiological research in diabetes published from 1 Jan 2017 to 1 June 2020. Machine learning approaches using tree-based learners-which produce decision trees to help guide clinical interventions-frequently have higher sensitivity and specificity than traditional regression models for risk prediction. Machine learning approaches using neural networking and "deep learning" can be applied to medical image data, particularly for the identification and staging of diabetic retinopathy and skin ulcers. Among the machine learning approaches reviewed, researchers identified new strategies to develop standard datasets for rigorous comparisons across older and newer approaches, methods to illustrate how a machine learner was treating underlying data, and approaches to improve the transparency of the machine learning process. Machine learning approaches have the potential to improve risk stratification and outcome prediction for clinical epidemiology applications. Achieving this potential would be facilitated by use of universal open-source datasets for fair comparisons. More work remains in the application of strategies to communicate how the machine learners are generating their predictions.

A Predictive Classification of Charcot Arthropathy of Foot and Ankle

Category:Diabetes; OtherIntroduction/Purpose:Charcot arthropathy of foot and ankle is a devastating, chronic and progressive destruction of bone and joint integrity affecting one or more joints. It is commonly associated with diabetes mellitus and is characterized by joint subluxations, dislocation, and pathological fractures in patients with peripheral neuropathy and results in a debilitating deformity, possibly leading to ulceration and amputation.Many classification systems exist for charcot arthopathy of foot and ankle. However, there is still lack of consensus regarding best classification. We are proposing a new classification for charcot arthropathy of foot and ankle based on our experience of large cohort of charcot patients. Our classification can guide treatment and prognosis of diabetic charcot arthropathy of foot and ankle, which we are following for the last decade.Methods:Patients with post-acute charcot who presented at our institution from January 2004 to October 2019 were reviewed and were further classified anatomically into Type I and Type II based on plain radiographs. Type I was characterized by charcot affection of one region. Regions were categorized anatomically as a modification of both Brodsky and Schon classifications into: ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint or calcaneus. Type II was characterized by affection of more than one region like peritalar, perinavicular, transverse tarsal or any other combination. Peritalar complex involves at least two joints of the following: ankle, subtalar, and talonavicular. The perinavicular type includes talonavicular and naviculocuniform or tarsometatarsal and naviculocuniform, while the transverse tarsal involves the calcaneocuboid and talonavicu-lar. Both types were further classified into four stages according to the stability, deformity and associated mechanical ulcers. (Table 1)Results:235 patients (242 feet) were presented with diabetic charcot arthropathy. Mean age was 56 years (range 22-84). Follow- up ranged from 6 months to 10 years, with a mean of 3.3 years.Types IA and IIA were managed conservatively. All patients in Type IIB, IC, IIC, ID, IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Stage IB ankle were fixed, while IB lisfranc were observed, and fixed if transformed to IC.Type II D had the highest complication rate in the form of: infection, nonunion, nail protrusion, implant failure, revision including exostectomy after full union and recurrence of ulcer in midfoot 3-4 years after surgery. Five patients ended up with amputation, and all were stage IID.Conclusion:For post-acute charcot, stage A have the best prognosis and can be managed conservatively provided good diabetes control.Type IB can be managed conservatively but when the ankle is affected in type IB, it is better to be elected for surgery.When charcot affects the Lisfranc joints, it is usually stable unless the lateral column is affected.All cases of type IIB, IC and IIC, ID, IID should receive surgery to achieve stability, correction of deformity and prevent complications.Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate. Type IID might predict the risk of amputation

Challenges of dealing diabetic foot and step wise surgical management

Soft tissue reconstruction of the diabetic foot is a challenge for the perioperative team. This study aims to describe a group of methods for the management of diabetic foot ulcers in order to reduce deformity and salvage the lower limb. This study emphasizes the appropriate timing and staging of surgery, discusses the most common plastic surgery techniques, and underscores the importance of a team approach in the management of diabetic foot wounds. A group of different advanced methods for the management of Diabetic foot such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done in Z. H. Sikder Womens Medical College Hospital where the treatments were given. The study period was Jan 2018 to July 2019. Thirty-four patients with type 2 and type 1 diabetes mellitus were enrolled in the current study. Females (61.05%) and males (38.95%) with different stages of diabetic ulcer and related problem underwent treatment within this time frame. They underwent different methods of surgical management: debridement (12%), vacuum therapy (24.06%), amputation (4.04%), skin grafting (38.00%) and flap reconstruction (21%). The outcome is satisfactory and offer less hospital stay. Using advanced surgical wound management including reconstructive plastic surgical procedures; it was possible to reduce the hospital stay, the rate of high amputations of the lower limb and the deformity.

Detection of Treponema spp. in bovine digital dermatitis in the Amazon biome, Brazil

ABSTRACT: Bovine digital dermatitis (BDD) is a polybacterial claw disease that is endemic to dairy cattle kept in loose house systems, and treponemas are the main bacteria implicated in this disease. The objective of this study was to report the occurrence of Treponema spp. in BDD from crossbred dairy cattle (Holstein x Zebu) kept in a pasture in the Brazilian Amazon biome. The diagnostic of BDD was performed by inspecting the distal extremities of cattle during milking in one or more visits comprising 15 farms. In total, it could be inspected 1,847 cows from August 2016 to July 2017, and 25 lesions of BDD were diagnosed. The feet were scored (System M: M0 = no lesion, M1 = ulcer stage &lt;2cm, M2 = ulcer stage &gt;2cm, M3 = healing stage, M4 = chronic stage, M4.1 = chronic stage with ulcer area). Twenty four biopsy samples were taken from feet with BDD and five biopsy samples from feet with no lesions. The histopathology of stained tissues was performed by hematoxylin and eosin and Warthin-Starry method. The samples were also tested by nested PCR for the three previously isolated BDD Treponema phylogroups (T. medium/T. vincentii-like, T. phagedenis-like and T. putidum/T. denticola-like). Spirochetes were observed in 54.2% (13/24) of the lesions, and in 91.7% (22/24) of the samples were detected the DNA of this spirochete belonging to the treponema phylogroups implicated in BDD. In 25% (6/24) of the lesions were detected all the phylogroups. Forty percent (40%, 2/5) of the M0 samples were also positive for the nested Polymerase Chain Reaction (nested-PCR), as 8.3% (2/24) of the lesions were negative in both techniques employed. Treponema putidum/T. denticola-like was the most detected bacterial in all the stages, and active lesions (M2 and M4.1) presented a greater proportion of T. medium/T. vincentii-like and T. phagedenis-like, but no statistical differences were observed (p&gt;0.05). It could be concluded that BDD lesions in crossbred dairy cattle kept to pasture in the Amazon biome were classified as “polytreponemal” infections and the phylogroup T. putidum/T. denticola-like was the most frequent in the lesions.

Bioinformatics analysis and systematic review of key genes and therapeutic traditional Chinese medicine of ulcerative colitis active stage

Data GSE75214 and GSE48959 that contained ulcerative colitis(UC) in the active stage was download from GEO database. Differential genes of UC in the active phase were obtained by using adjusted P&lt;0.05 and |log_2 FC|≥1.5, which was the screening criteria. PPI analysis was performed in the STRING database, and GO and KEGG pathway analysis was performed in DAVID database. Cytoscape was used to visualize differential genes, and calculate key genes in the active phase. Coremine Medical was used to analyze and systematically evaluate traditional Chinese medicines for treating key genes. Finally, 139 differentially expressed genes in the active phase were screened out, which included the 109 up-regulated genes and 30 down-regulated genes. DAVID analyzed that the biology and pathways of these differential genes were mainly concentrated in inflammatory response, immune response, chemokine activity, TNF pathway, NF-κB pathway, and Toll-like receptor pathway. Cytoscape software calculated that IL-6, CXCL8, IL-1β, MMP9, CXCL1, ICAM1, CXCL10, TIMP1, PTGS2 and CXCL9 were the key genes of UC in the active phase. According to Coremine Medical analysis, traditional Chinese medicines for UC in the active stage included Curcumae Longae Rhizoma, Scutellariae Radix, Curcumae Radix had clearing heat clearing damp, reducing fire and detoxifying effects, which was in line with the pathogenesis of UC active stage, and was often used in clinical treatment of dampness-heat diarrhea. Therefore, Huangqin Decoction, which Scutellariae Radix was the principal drug, was selected for systematic evaluation. The evaluation showed that Scutellariae Radix was superior to Western medicine in terms of improving clinical efficiency, reducing inflammatory factors and immunoglobulin levels, with statistically significant differences and fewer adverse reactions. This study provided a new idea for further research on the pathogenesis of UC in the active phase by analyzing the genes and their mechanism of action, and the systematic evaluation of Chinese medicine for the treatment of UC active stage provided a basis for the clinical prevention and treatment of UC by Chinese medicine.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective: To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes. Methods: From January 2018 to December 2018, 86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group. The control group received the routine publicity and education and visiting, while the observed group adopted the cooperative nursing model of medical treatment combination. Then compare the healing status and nursing satisfaction of the two groups. Results: Of the 43 patients with pressure ulcers in the observed group, 18 had been in the second stage of pressure ulcers and 16 had been healed; 14 had been in the third stage of pressure ulcers and 8 had been healed; 11 had been in the fourth stage of pressure ulcers and 5 had been healed. The nursing satisfaction of the patients in the observed group was 95.35%. Conclusion: Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’ and their families’ awareness of pressure ulcer nursing, standardize their nursing behaviour, help recover the patients themselves and promote the patients’ satisfaction.

Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant).

Background:Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.Materials and methods:A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT 04037475. Registered on July 2019.

Non-Targeted Metabolomic Analysis Reveals Serum Phospholipid Alterations in Patients with Early Stages of Diabetic Foot Ulcer.

Diabetic foot ulcer (DFU) is a common complication of type 2 diabetes mellitus (T2DM) characterized by ulcer formation, which can lead to the amputation of lower extremities. However, the metabolic alterations related to this complication are not completely elucidated. Therefore, we carried out a metabolomic analysis of serum samples obtained from T2DM adult patients diagnosed with diabetic foot ulcer in a cross-sectional, observational, and comparative study. Eighty-four volunteers were classified into the following groups: without T2DM (control group, n = 30) and with T2DM and different stages of diabetic foot ulcer according to Wagner-Meggitt classification system: DFU G0 (n = 11), DFU G1 (n = 14), DFU G2 (n = 16), and DFU G3 (n = 13). The non-target metabolomic profile followed by chemometric analysis revealed that lysophosphatidylethanolamine (16:1) could be proposed as key metabolite related to the onset of diabetic foot ulcer; however, this phospholipid was not affected by diabetic foot ulcer progression. Therefore, further studies are necessary to validate these phospholipids as biomarker candidates for the early diagnosis of diabetic foot ulcer in T2DM patients.

Quality of Life and Increasing Role of Biomarkers in Diagnosis, Prognosis and Prediction of Diabetic Foot Ulcer

Diabetic foot ulcer (DFU) is a long term serious complication associated with diabetes and is defined as the ulceration in diabetic patients caused due to peripheral neuropathy and peripheral arterial disease of lower limbs. It is one of the major and leading causes of lower extremity amputations and increased morbidity. Increased podiatric pressure, abnormal glycemic parameters and many other causes leads to healing and non-healing ulcers in diabetic patients. Quality of life in DFU patients vary depending upon the stages of ulcers and duration of ulcers. DFU patients with healed ulcer will have higher quality of life than the patient with non-healed and chronic ulcers. Health related quality of life decreased progressively with the poor healing of wounds. In current scenario biomarkers are playing a major role in drug discovery, preclinical pharmacological studies, clinical trials and post marketing studies. The general biomarker discussed in this review are transforming growth factor, procalcitonin, calprotectin, cystatinC, Osteoprotegerin-1, edothelin-1, CXCL-6, CXCL-12, Epithelial neutrophil activator, hypoxia inducible factor-1, Growth factors, Nitric oxide, Stem progenitor cell, Matrix metalloproteinase, Fibrinogen and Serpin B3. These above mentioned biomarkers are gaining importance in current scenario thus reducing morbidity and mortality rate.

Hyperbaric oxygenation in prevention of amputations of diabetic foot

Background/Aim. Diabetic foot is the term for the pathological changes on foot in patients with diabetes. It is caused by diabetic angiopathy, polyneuropathy and osteoarthropathy. The treatment is complex and long-term and often leads to the loss of the extremity. The appliance of hyperbaric oxygen therapy (HBOT) has a lot more important place in adjuvant treatment of this disease. The aim of this study was to determine the influence of HBOT on the wound healing in comparison with the conventional treatment, the possibility of shortening the time of the treatment in patients with diabetic foot. Methods. In a fiveyear period a retrospective-prospective multicentric study, involving 60 patients with diabetic foot divided into two groups, was performed. The first group (group A) consisted of 30 patients treated by combined therapy (with medications, surgical therapy and HBOT). All the patients were receiving HBOT in the Special Hospital for Hyperbaric Medicine, CHM Hollywell-Neopren in Belgrade. The control group (group B) also consisted of 30 patients treated with medications and surgical therapy, but without HBOT. Results. The demographic data, the types of diabetes, as well as the Wagner classification stage of diabetic ulcers and radiography scans of changes in bones were equal in both groups. The median healing time of the Wagner grade III ulcer in the group A was 37.36 days [mean ? standard deviation (SD) = 65.6 ? 45.8 days], and in the group B 99.78 days (mean ? SD = 134.8 ? 105.96 days) and it was statistically significant (p = 0.074). The median time of recovery in patients of the group A with the Wagner grade IV was 48.18 days (mean ? SD = 49.7 ? 33.8 days), and in the group B 85.05 days (mean ? SD = 86.7 ? 71.6 days) and that was statistically significant (p = 0.121). The foot amputations were performed in both groups in 3 (10%) patients. In the group A there were no high amputations, whereas in the group B there were 4 (13.33%) below-knee amputations and 4 (13.33%) above-knee amputations which was highly statistically significant (p &lt; 0.0001). Conclusion. In this study, HBOT definitely showed positive adjuvant role in the treatment of diabetic foot. For the good treatment result it is essential the timely and successful surgical treatment of the ulcer and the use of bandage with the healing dressings. In case of the clear signs of local infection, the antibiotic therapy according to the antibiogram is necessary.

Effectiveness of a Pressure Ulcer Prevention Package (PUPP) for Patients Admitted in Intensive Care Units: An Experimental Study

Many critically ill patients admitted in ICUs sedated on mechanical ventilation are unable to change the position themselves. Therefore, these patients are at high risk of impaired skin integrity that leads to development of pressure ulcers. This study assessed the effectiveness of pressure ulcer prevention package in reducing the incidences of pressure ulcers among patients in ICUs. In this experimental design pre-test post-test control group study, 70 patients 35 each in experimental and control group from different ICUs of Dr RML Hospital, New Delhi were randomly allocated into two groups i.e. experimental and control groups. Experimental group received the intervention of pressure ulcer prevention package and the control group received routine skin care. Demographic and clinical data were collected by using demographic pro'Agrave;le tool, standardised skin assessment tool and pressure ulcer staging tool. All the subjects were followed every third day from admission to discharge, death and up to a maximum 20 days. Data were analysed using STATA 11.1 with the level of signi'Agrave;cance at p'lt;0.05. Descriptive and inferential statistics were used. The sacrum and then heels were the most common areas of pressure ulcers among ICU patients. Pressure ulcer prevention package was signi'Agrave;cantly effective (p'lt; 0.001) to delay the pressure ulcers-related adverse events among patients of experimental group. Pressure ulcers-related adverse events were developed earlier in control group i.e. 14 percent in experimental and 41 percent in control group. Number of pressure ulcers development were signi'Agrave;cantly (p'lt;0.001) lower in experimental group (08/35) compared to control group (20/35). The experimental group had signi'Agrave; cantly less Stage I and Stage II pressure ulcers development compared to control group (p'lt;0.001). Pressure ulcers prevention package was found to be signi'Agrave;cantly effective to reduce incidences, severity and total number of pressure ulcers among patients admitted in ICUs.