Treatment Of Ulcers Research Articles

Physiotherapy Intervention in the Treatment of Venous Ulcers: Results from a Delphi Panel

Background/Objectives: Venous ulcers are the most common type of ulcerated wounds in the lower limbs and result from chronic venous insufficiency. The treatment of venous ulcers is multidisciplinary, with physiotherapy intervention serving as an adjuvant therapy in managing these wounds. This study investigated physiotherapeutic interventions for the management of venous ulcers. Methods: This was an exploratory and descriptive study using the Delphi method. The panel comprised 12 experts in wound care, including 25.0% physicians, 41.7% nurses, and 33.3% physiotherapists. Two rounds of analysis were conducted. A quantitative analysis was performed to assess the level of agreement in responses, while qualitative analysis was applied to the experts’ comments. Results: In the first round, consensus varied between 80% and 100%, and in the second round, it ranged from 83.3% to 100%. In the second round, all interventions obtained at least 80% consensus. The interventions included the use of compression therapy and therapeutic exercise: resistance training (2–3 sets of 10–25 repetitions, 3 times/day, for at least 12 weeks), aerobic exercise (at least 30 min, 3 times/week, for 12 weeks), stretching, balance training, and the use of a vibrating platform. Conclusions: Physiotherapy may be beneficial as an adjuvant therapy alongside specific local treatments for venous ulcers. Therapeutic exercise and compression therapy are commonly utilized interventions that could support overall treatment outcomes.

Local treatment of disintegrating breast tumors

The group of patients with stage 4 disease has the worst prognosis and treatment results, with a decaying tumor ulcer forming in 2–5% of cases. Treatment of skin tumor ulceration includes antitumor therapy combined with local treatment of the tumor ulcer. Local treatment of decaying tumors consists of sanitation, washing with antiseptic solutions, and clearing the ulcer of necrotic masses by mechanical, chemical, and enzymatic methods. Bleeding is the most important problem of symptomatic treatment. “Hemostatic collagen sponge with silver” due to the combination of components not only stops capillary bleeding, but also promotes epithelialization of the wound defect against the background of antiseptic action.

Enhancing Drug Recommender System for Peptic Ulcer Treatment

Drug Recommender Systems (DRS) streamline prescription process and contribute to better healthcare. Hence, this study developed a DRS that recommends appropriate drug(s) for the treatment of an ailment using Peptic Ulcer Disease (PUD) as a case study. Patients’ and drug data were elicited from MIMIC-IV and Drugs.com, respectively. These data were analysed and used in the design of the DRS model, which was based on the hybrid recommendation approach (combining the clustering algorithm, the Collaborative Filtering approach (CF), and the Knowledge-Based Filtering approach (KBF)). The factors that were considered in recommending appropriate drugs were age, gender, body weight, allergies, and drug interactions. The model designed was implemented in Python programming language with the Flask framework for web development and Visual Studio Code as the Integrated Development Environment. The performance of the system was evaluated using Precision, Recall, Accuracy, Root Mean Squared Error (RMSE) and usability test. The evaluation was carried out in two phases. Firstly, the CF component was evaluated by splitting the dataset from MIMIV-IV into a 70% (60,018) training set and a 30% (25,722) test set. This resulted in a precision score of 85.48%, a recall score of 85.58%, and a RMSE score of 0.74. Secondly, the KBF component was evaluated using 30 different cases. The evaluation for this was computed manually by comparing the recommendation results from the system with those of an expert. This resulted in a precision of 77%, a recall of 83%, an accuracy of 81% and an RMSE of 0.24. The results from the usability test showed a high percentage of performance of the system. The addition of the KBF reduced the error rate between actual recommendations and predicted recommendations. So, the system had a high ability to recommend appropriate drug(s) for PUD.

Invivo and ex-vivo evaluation and characterization of wound healing effect of topical calendulaofficinalis and turmeric cream in diabetic rats.

Objective: To evaluate wound healing by topically administration of calendulaofficinalis and tumeric cream to diabetic rats. Study Design: Observational Cross-sectional study Setting: Department of Pharmaceutics, Faculty of Pharmacy, BahaUddin Zakariya University, Multan, Pakistan Period: October 2020-march 2021. Method: Different batches of hydrophilic cream bases (C1-C6) were developed and characterized. The optimized base composition (C6) was loaded with calendula Officinal is extract and turmeric powder as an active ingredient (C7) and evaluated the rate at which wounds heal in diabetic rats. Calendula officinal is and turmeric were combined in a cream, as different stability parameters of the creams were analysed at different temperature. Microbiological action of the cream was also examined. Results: The formulation was homogenous, stable with pH 6.29±0.03, viscosity 381± 6.96 Cps and the microbiological quality met the requirements of European pharmacopeia. The total flavonoid content was less than 1. The formulation showed accelerated wound healing with more than 95% wound contraction after tenth day. Conclusion: The result were favorable and suggested that topical administration of Calendula officinal is and turmeric powder combination would enhance wound healing in diabetic rats with potential for diabetic foot ulcer treatment. Moreover, the designed formulation poses good quality emulsion system stabilizing the active ingredient as well as appropriate release of medicinal agents.

A multifunctional bacterial cellulose-based dressing modified by quaternized chitosan and grafted protocatechuic acid for diabetic ulcer.

Herein, we developed a multifunctional bacterial cellulose-based dressing (PHBC) modified by quaternized chitosan (HACC) along with protocatechuic acid (PA), through in situ biosynthesis combined with covalent immobilization. The obtained PHBC dressing maintained the excellent physicochemical characteristics of BC, such as high porosity (above 76 %); high water absorption ratio, >80 % of water absorption rate (approximately 30 g/g) has completed in half an hour; favorable hydrophilicity with contact angle of about 50° and excellent flexibility. The introduction of PA-grafted HACC endows exhibited outstanding antibacterial properties against, anti-inflammatory performance and antioxidant capacity. Furthermore, PHBC II, with the reaction solubility of PA was 3 mg/mL, could promote NIH3T3 and HUVECs proliferation and spread. In vivo experiments further verified that PHBC II can effectively promote new granulation tissue hyperplasia and collagen deposition and expression around diabetic ulcers, reduce the inflammatory phenomenon around the wound, and promote the internal capillaries of the wound. The repair and regeneration of the network can promote better and faster wound healing. These results illustrate that the PHBC functional dressing has an important reference value for the clinical treatment of diabetic ulcers.

Medicinal Herbs for the Treatment of Peptic Ulcers

: Peptic ulcers are common gastrointestinal disorders characterized by the erosion of the stomach lining, duodenum, or esophagus. Conventional treatments, such as proton pump inhibitors and antibiotics for Helicobacter pylori eradication, have been the mainstay of therapy. However, the emergence of drug resistance and potential side effects have led to the exploration of alternative and complementary approaches, including medicinal herbs. This comprehensive review examines the potential use of medicinal herbs in the management of peptic ulcers. Ten herbal remedies, including Liquorice, Slippery Elm, Marshmallow Root, Aloe Vera, Chamomile, Ginger, Turmeric, Meadowsweet, Fenugreek, and Cabbage, are analyzed for their therapeutic properties and scientific research findings. These herbs have demonstrated anti-inflammatory, antimicrobial, and mucoprotective effects that may support ulcer healing and symptom relief. Herbal formulations, such as teas, capsules, tablets, and extracts, offer convenient delivery methods for patients seeking herbal remedies. However, safety considerations and potential herb-drug interactions must be carefully monitored. Integrating herbal remedies with conventional treatments presents a comprehensive approach to peptic ulcer management. By combining these therapies, patients may experience enhanced therapeutic outcomes and improved quality of life. Dietary recommendations also play a crucial role, with the inclusion of soothing and beneficial foods, while avoiding trigger foods that may exacerbate symptoms. As the evidence base grows, collaborative efforts between traditional herbal medicine practitioners and mainstream medical professionals are vital to ensure safe and effective integration.

Fighting H. pylori with Medicinal Plants: A Study on Jordan's Traditional Remedies

Aims of the Study: This study was designed to evaluate the antimicrobial activity of some medicinal plants used among Jordanians for the treatment of gastritis and gastric ulcers against H. pylori. Moreover, plants' inhibitory activity against the H. pylori urease enzyme was also evaluated. Materials and Methods: The activity of 11 medicinal plants used by common people and herbalists to treat ulcers was evaluated against H. pylori (NCTC 11916). Ethanol and essential oil extracts from the tested plants were evaluated using a standard agar dilution method and the MICs were determined. Furthermore, the potential inhibitory effect of each preparation was tested against the enzyme urease using a kinetic colorimetric assay. Results: Cinnamomum cassia oil showed the highest efficiency against H. pylori with the lowest MIC (0.0122 mg.mL-1), followed by Origanum syriacum and Foeniculum vulgare (MICs of 0.39 mg.mL-1). Furthermore, significant urease inhibition activity was recorded for Carum carvi oil (IC50~0.45 mg.mL-1). C. cassia oil (IC50 ~2.8 mg.mL-1), Aloysia citriodora, and Artemisia Judaica (IC50 5.8 mg.mL-1) reported potential urease inhibition activities. Conclusion: Herbs used in Jordanian traditional medicine were found to have anti-H. pylori and significant urease inhibitory activity. These findings might support the use of medicinal plants as adjuvant or alternative therapy for the treatment of H. pylori.

Use of autologous tissue regeneration matrix (pro prf) in the treatment of diabetic ulcers: case series

Introduction: diabetes mellitus significantly contributes to chronic ulcers, with over 30% of diabetics over 40 affected by lower limb ulcers, which can lead to severe complications if untreated. The Progressive Platelet Rich Fibrin (PRO-PRF) tissue regeneration matrix can be a technique to improve the dimensions of the membrane, its strength and cell distribution, aiding in the treatment of tissue reconstruction. Objective: to describe a series of cases of diabetic ulcers treated with autologous tissue regeneration matrix (PRO-PRF). Methods: a prospective, interventional case series study using a new tissue regeneration matrix protocol for the treatment of diabetic ulcers. This is an autologous matrix obtained by collecting peripheral blood and centrifuging it in a protocol of progressively increasing speeds. Results: 29 patients were evaluated with a mean age of 60.54±9.75 years. 82.8% of the sample was male with an average body mass index (BMI) of 29.29±8.04Kg/m2 . Most of the lesions (41.4%) were located on the hallux. The median number of days of treatment was 14 (25% percentile of 7 and 75% percentile of 63 days). Statistical analysis showed a significant reduction in the size of the ulcers after treatment with PRO-PRF. Conclusion: the use of PRO-PRF proved to be an easy-to-use, low-cost and effective therapeutic option for treating chronic skin wounds on diabetic feet.

To Evaluate Anti-Ulcer Activity of Nux Vomica for the Treatment of Gastric Ulcer

This study aimed to determine the anti-ulcer activity of Nux Vomica for the Treatment of Gastric Ulcer. Present study was clinical study with simple randomized single blind drug evaluation method. As per study design and methodology all patients were treated with homoeopathic treatment only. Hence control study or comparison with modern medicine is out of framework of the present study. To evaluate curative efficacy of Nux Vomica and to show that is better than modern line of treatment in Gastric ulcer it has been used for comparison. After this research work it has been seen that lot many gastric ulcer patient got cured and healed by Nux Vomica. The conclusion is that patient compliance, trust economic status is indeed an important strategy in the used of any medicine system benefits with correct dose. Homeopathy and Allopathic medicines continue potentially impacting on the attainment of 'health' as a society in its entirety. No doubt, in cases of short and long time treatments of illness both medicine systems have their own importance and earlier have done more than the miracles and have proven life saving for everybody.

Evaluation of anti-ulcer and analgesic activity of Annona squamosa leaves

In the present research work, medicinally important dried leaves of Annona squamosa were demonstrated for the identification of phytochemical compounds and Pharmacological activities. Plants were very important in medicinal field; they have similar properties as conventional drugs. Medicinal plants are safer due to their lower chances of adverse effects and better compatibility to human being. Different solvents are used to extract the biological compounds present in the leaves; among them methanol shows more biological compounds. Chemical constituents derived from plant source have a very long history in treatment of human diseases. Nearly 70% of new chemical entities reported during the past decades were from natural products. In the present study, on abdominal section histopathological observation for analgesic and antiulcer activities were reported. Analgesic activity was observed to the level of clinical importance, this activity was due to the presence of flavonoids and antiulcer activity exhibited due to mucosal defensive factor, than can be used for treatment of peptic ulcer. Further research is required to identify the active phytoconstituents present in the extract and experimentation on the healing action of drug as well as less side effects. The present investigation on mode of action may give way for establishment of new anti-ulcer and analgesic activity.

Successful treatment of ulcers of bullous morphea with platelet-rich fibrin therapy

Successful treatment of ulcers of bullous morphea with platelet-rich fibrin therapy

FABRICATION OF TRANSDERMAL PATCHES

Transdermal delivery leads to over-injectable and oral routes by increasing patient compliance and avoiding the first-pass metabolism, respectively. The aim of this study is to fabricate & evaluate the transdermal patches of proton pump inhibitor (PPI) for treatment of peptic ulcer. Pantoprazole is extensively metabolized in the liver, and to overcome these problems the current study was aimed to formulate a transdermal drug delivery system for it. In this study different polymers (HPMCE5 with PVPK30 and HPMCE5 with EudragitL100) used in different ratios. Solvent evaporation method were used to fabricate the transdermal patches. Patches were assessed for their thickness, folding endurance, weight uniformity, content uniformity, swelling index, percentage moisture content, moisture uptake, surface pH.

A Natural Eumelanin-Assisted Pullulan/Chitosan Hydrogel for the Management of Diabetic Oral Ulcers.

Existing methods for treating diabetic oral ulcers often fall short in clinical environments due to potential bacterial contamination, oxidative harm, and hindered angiogenesis throughout the healing process. Here, a hydrogel patch (HYG2) have been developed for local in situ application. HYG2 comprises oxidized pullulan, quaternized chitosan, and eumelanin nanoparticles derived from cuttlefish ink. These components work together to efficiently heal wounds associated with diabetic oral ulcers. Application begins with a simple local injection that quickly forms a protective barrier over the mucosa, effectively stopping bleeding and counteracting inflammatory agents. HYG2 is distinguished by its strong antibacterial properties and capacity to eliminate reactive oxygen species, promoting bacteria clearance and managing oxidative stress, which accelerates the healing phase from inflammation to tissue regeneration. Additionally, HYG2's 3D structure, incorporating elements from natural sources, offers exemplary support for structural and nutritional cell needs. This enhancement fosters cell adhesion, migration, and proliferation, along with further angiogenesis during mucosal remodeling. Ultimately, HYG2 is fully absorbed by the body after serving its therapeutic functions. Evidence from in vitro and in vivo studies shows that HYG2 hydrogel markedly accelerates mucosal wound repair, making it a promising treatment for diabetic oral ulcers.

Treatment of exposed tibial bone by old school burr holes – a case report

Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

Biogenic Nanoparticles as Safer Alternatives for Gastric Ulcers: An Update on Green Synthesis Methods, Toxicity, and Their Efficacy in Controlling Inflammation.

Peptic ulcers, affecting approximately 10% of the global population, can result from factors such as stress, alcohol use, smoking, NSAIDs, Helicobacter pylori infection, and genetic predisposition. Plant-based medicines are gaining recognition for their therapeutic potential, including in the treatment of peptic ulcers. Green chemistry methods for the biological synthesis of nanoparticles (NPs) provide a sustainable alternative to traditional chemical techniques. These nanoparticles, particularly metallic NPs and metal oxides synthesized from plant extracts, offer promising anti-ulcer properties. This review highlights research from 2000 to 2024 on the use of green-synthesized nanoparticles and their role in peptic ulcer treatment, focusing on their therapeutic mechanisms and potential benefits. For this purpose, an electronic search of published research and review articles was conducted in PubMed, Scopus, Science Direct, Cochrane databases, and Google Scholar.

Peptides in the Treatment of Gastric Ulcer.

A promising area in the search for effective and safe methods of pharmacotherapy for gastric ulcers is the study of bioactive substances of natural origin and derivatives synthesized on the basis of these substances. The review presents modern information on various peptide-based substances that are pharmacologically active against gastric ulcer, including analogues of natural neuropeptides, synthetic substances with a specific amino acid sequence, as well as drugs derived from biological peptide complexes. Based on the results of the analysis, we have assessed the prospects of this pharmacological approach and outlined the areas for further research.

Integrated chemical analysis, metabolic profiling, network pharmacology, molecular docking and toxicity prediction to reveal the active ingredients and their safety of raw and prepared rhubarbs in the treatment of gastric ulcers.

Rhubarb, containing raw rhubarb (RR) and two processed products (steamed rhubarb, SR; carbonized rhubarb, CR), is commonly used in high-doses for the treatment of peptic ulcer, especially gastric ulcer (GU). However, their active ingredients, therapeutic targets, and potential mechanism remain unclear. Meanwhile, the safety of these active ingredients is also worth studying. An offline two-dimensional low-pressure liquid chromatography/high-performance liquid chromatography coupled with high resolution mass spectrometry method was applied to identify the chemical constituents of RR, SR, and CR. Then, the plasma and urine samples of rats after oral administration of RR, SR, and CR were studied for metabolite profiling. Based on the analysis of ingredients in vivo, the key active constituents, core therapeutic targets and key signaling pathways of RR, SR, and CR against GU were screened via network pharmacology and molecular docking. Finally, the efficacy and safety of these key active ingredients were evaluated. Totally, 183, 120 and 115 compounds were identified or tentatively characterized from RR, SR and CR, respectively. Meanwhile, 190, 182 and 180 components were identified after oral administration of RR, SR and CR. By network pharmacology and molecular docking, torachrysone, hydroxyemodin, 6-methylrhein, rhein and emodin anthrone might be the predominant effective constituents in RR, SR, and CR with AKT1 and EGFR being their key targets during the treatment of GU. Moreover, EGFR/PI3K/AKT signaling pathway might play a crucial role in the therapeutic mechanism of GU. In silio ADMET predictions categorized 5 compounds as drugs with good oral bioavailability, but these components may induce liver injury. Overall, our results not only clarified the active substances and molecular mechanism for enhancing our understanding about the traditional efficacy, but also pay attention to the clinical safety issues of raw and prepared rhubarbs.

Photodynamic therapy in the complex treatment of trophic ulcers of venous etiology

Photodynamic therapy in the complex treatment of trophic ulcers of venous etiology

Role of intralesional platelet-rich plasma (PRP) therapy in the treatment of recalcitrant oral ulcers of pemphigus vulgaris

Pemphigus Vulgaris is a chronic, autoimmune vesiculobullous disorder in which 80-90% of patients develop oral lesions and in 60% of cases, oral lesions are the first sign. The platelet-rich concentrate present in autologous platelet-rich plasma (PRP) therapy has a high concentration of growth factors that promote the synthesis of collagen and extracellular matrix. The wound healing property of PRP can be used to treat recalcitrant oral ulcers of pemphigus as it accelerates the healing process, prevents the patients from side effects of steroids, and reduces the pain and discomfort of the patients. To assess the role of intralesional Platelet Rich Plasma (PRP) therapy in the treatment of recalcitrant oral ulcers of pemphigus vulgaris. A total of 15 histo-pathologically proven cases of Pemphigus Vulgaris under treatment, in whom the skin lesions had healed up to 90% but the oral ulcers were still persistent were included in the study. The severity of the ulcers were monitored by calculating the POLIS (Pemphigus Oral Lesion Intensity Score). Autologous intralesional PRP was administered in 3 sittings 7 days apart and the result was evaluated by change in POLIS score after each sitting. The data was analyzed using SPSS IBM version 26.0. Out of the total cases, 12 patients were female and 3 were male. Intralesional PRP was found to accelerate the healing of recalcitrant oral erosions. It was found that POLIS was reduced after every PRP session. The paired t-test was conducted to compare the mean scores of POLIS-0 and POLIS-3. The result indicates a significant difference between the pre-intervention mean score POLIS-0 (M=19, SD=3.25) and post-intervention mean score POLIS-3 (M=6.6, SD=2.97), t(14)=13.33,p<0.001. Intralesional PRP has been found to improve the recalcitrant oral ulcers of pemphigus vulgaris. Hence, it can be a treatment option where oral and topical corticosteroids fail to respond or are contraindicated.

The Potential of Mesenchymal Stem/Stromal Cells in Diabetic Wounds and Future Directions for Research and Therapy-Is It Time for Use in Everyday Practice?

The treatment of diabetic wounds is impaired by the intricate nature of diabetes and its associated complications, necessitating novel strategies. The utilization of mesenchymal stem/stromal cells (MSCs) as a therapeutic modality for chronic and recalcitrant wounds in diabetic patients is an active area of investigation aimed at enhancing its therapeutic potential covering tissue regeneration. The threat posed to the patient and their environment by the presence of a diabetic foot ulcer (DFU) is so significant that any additional therapeutic approach that opens new pathways to halt the progression of local changes, which subsequently lead to a generalized inflammatory process, offers a chance to reduce the risk of amputation or even death. This article explores the potential of MSCs in diabetic foot ulcer treatment, examining their mechanisms of action, clinical application challenges, and future directions for research and therapy.