Debridement Of Ulcers Research Articles

Effect Of Virtual Reality On Pain In Diabetic Foot Ulcer Patients

Background: Diabetes Mellitus (DM) is a heterogeneous group of disorders characterized by increased blood glucose levels or hyperglycemia which can cause complications such as Diabetic Foot Ulcer. Debridement can cause the patient to experience pain. A nursing intervention that can be used to reduce pain during the debridement of diabetic ulcers is a distraction. VR (Virtual Reality) become a popular distraction device to reduce pain. The purpose of this study was to analyze the effect of Islamic audio-visual therapy by using virtual reality on pain in the treatment of diabetic ulcers. Methods: This type of research uses a quantitative research type with Quasi-experimental with the One Group Pre-Post Test Design approach. The population in this study were diabetes mellitus ulcer pain patients at the Semarang Foid Clinic with a total of 26 patients with a total sample using 26 samples. The instrument used was the pain observation sheet. Data analysis used the Wilcoxon test. Results: the majority were male 65.4%, the majority had a high school education 42.3%, the majority suffered 1-2 months 73.1% and the majority had a grade I Diabetes Mellitus ulcer 65.4%. The results of p-value 0.001 <0.05 can be interpreted that there is an effect of Islamic audio-visual therapy on pain in diabetic ulcer care. Conclusion: This study provides an effect of Islamic audio-visual therapy by using virtual reality on pain in diabetic ulcer care. VR has an effective effect on lower pain in DFU patients. In future research, more detailed criteria are required, such as patients with similar diseases, same age group, and more participants to study.

Asymmetric, Bilateral Nontraumatic Subperiosteal Orbital Hematomas in an Anticoagulated Patient Following Anesthesia in Prone Positioning.

The authors report a case of nontraumatic orbital subperiosteal hematoma after general anesthesia with patient in the prone position. The patient, who was on aspirin, clopidogrel, and subcutaneous heparin, presented immediately after sacral ulcer debridement with acute bilateral vision loss and periorbital edema. While the OD improved with conservative management, the OS continued to have 20/200 vision, decreased color vision, afferent pupillary defect, and extraocular movement limitation after lateral canthotomy and cantholysis. Imaging revealed bilateral subperiosteal hematomas in the superior orbital roof stretching the posterior optic nerve. Left orbitotomy with drainage of hematoma under anesthesia was then performed, with full resolution of symptoms and recovery of vision to 20/20 by postoperative week 2. While a few cases of orbital subperiosteal hematoma after nonophthalmic surgeries have been previously reported, the majority were in the supine position, unilateral, and resolved without surgical decompression. This case suggests that the increase in venous pressure from prone positioning, especially in patients on anticoagulation or antiplatelet therapy, could contribute to bleeding into the subperiosteal space. Furthermore, although the orbital compartment syndrome and elevated intraocular pressure resolved with canthotomy/cantholysis, there was persistent compressive optic neuropathy that required surgical intervention.

MANEJO DE FERIDAS EM COELHO ATRAVÉS DO USO DA PELE DE TILÁPIA LIOFILIZADA

The study addresses the importance of treating skin lesions in veterinary medicine, with an emphasis on wound healing in rabbits with pododermatitis, including the use of Nile tilapia skin as a therapeutic alternative for grafting after debridement of necrotic ulcers. Skin lesions can be caused by trauma, bites or other causes, compromising vital skin functions, such as protection and defense against infections. Tilapia skin is rich in type I collagen and has been highlighted as an accessible and effective biomaterial in the treatment of wounds, stimulating cell regeneration and healing. The work reports the case of a rabbit, named Paçoca, diagnosed with ulcerative pododermatitis in the left pelvic limb, a chronic condition that can lead to serious complications. The clinical signs of the pathology are pain, abdominal and limb alopecia, edema, ulcerative lesions, loss of joint mobility with the presence of osteolytic reactions. Pododermatitis in rabbits is often related to factors such as cage floor quality, excess weight, and sedentary lifestyle. The rabbit’s treatment included debridement of necrotic tissue and the application of tilapia skin as a graft. The tilapia skin was prepared through a rigorous sterilization and preservation process, involving immersion in specific solutions and the application of antibiotics. The use of this skin as an occlusive dressing helped stimulate growth factors essential for skin regeneration, such as fibroblasts and keratinocytes. The use of this biomaterial proved effective in the treatment of wounds with significant tissue loss, avoiding the need for sutures and promoting healing through the formation of new tissue. Postoperative follow-up included the use of antibiotics and anti-inflammatories, and treatment with tilapia skin contributed to the successful recovery. The study highlights the effectiveness of the biomaterial in the management of skin wounds in rabbits, especially in the recovery of lesions caused by ulcerative pododermatitis. Therefore, after treatment, the rabbit presented good healing, the wound evolved positively, with formation of granulation tissue and epithelialization.

Efficacy and safety of digital nerve block for pain management during sharp debridement of digital ulcers in systemic sclerosis: A prospective observational study.

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis and vascular abnormalities, often leading to the development of digital ulcers (DUs). DUs are painful and debilitating, significantly impacting patients' quality of life. Effective pain management during debridement is crucial, yet there is no consensus on the optimal approach. This study evaluates the efficacy and safety of digital nerve block (DNB) using lidocaine and mepivacaine for pain control during sharp debridement of DUs in SSc patients. This prospective observational study was conducted from September 2023 to May 2024 at the Rheumatology Operating Unit, University of Verona. Patients were randomized to receive either 1 mL of 2% lidocaine or 2% mepivacaine for DNB. Pain levels were assessed using a categorical grading scale during the injection and debridement. The outcomes were pain control and performance of lidocaine versus mepivacaine. The cohort developed 46 ulcers. The pain was abolished in almost all patients. Lidocaine achieved faster anaesthesia (127.92 ± 34.32 s) compared with mepivacaine (252.65 ± 49.89 s, p < 0.001). Mepivacaine resulted in less pain during injection (p = 0.006). No significant difference in pain levels during debridement was observed between the two anaesthetics. Three mild adverse effects (Raynaud's phenomenon) were reported. All procedures were completed successfully, and 35 ulcers healed with a mean time of 6.1 ± 7.77 weeks. DNB with mepivacaine provides effective pain control during DU debridement in SSc patients, with lower injection site pain and comparable efficacy to lidocaine. The procedure is safe, well-tolerated and facilitates successful ulcer healing. Further studies with larger cohorts are warranted to confirm these findings.

Results of the Phase 1 Open-Label Safety Study of Umbilical Cord Lining Mesenchymal Stromal/Stem Cells (Corlicyte®) to Heal Chronic Diabetic Foot Ulcers.

Mesenchymal stromal/stem cells (MSCs) play a critical role in wound healing. Corlicyte® is an MSC product derived from allogeneic umbilical cord tissue donated under an institutional review board-approved protocol and processed in accordance with section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act. This open-label phase 1 trial was performed under a United States Food and Drug Administration Investigational New Drug Application to establish the safety and tolerability of Corlicyte® in patients with diabetes and chronic diabetic foot ulcer (DFU). Escalating doses were applied topically twice a week for up to 8 weeks after ulcer debridement, wound photography, and measurement. Subjects were followed for 4 weeks after the treatment phase. Adverse events were assessed at every visit. Nine subjects in 2 dosing cohorts completed the trial. No subjects experienced a serious adverse reaction to Corlicyte® or the development of anti-human leukocyte antigen (HLA) antibodies. Sixty percentage of subjects in the lower dose cohort experienced ulcer closure by Day 70 of follow-up, while the mean ulcer size was reduced by 54-67% in the other subjects. Topical administration of Corlicyte®, a novel biologic therapy consisting of allogeneic umbilical cord lining MSCs, appeared safe and tolerable and resulted in a significant decrease in ulcer area, demonstrating its potential as a therapy for healing of chronic DFU.

Diabetic foot gangrene - A case study

Diabetic foot is a major public health issue which may lead to leg amputation and thus resulting in disability, reduction in the quality of life and high treatment cost. Non healing ulcer turning into gangrene is a common consequence of diabetic foot. Thus, saving the limb and healing of the leg ulcer are the major challenges faced in case of diabetic foot disease. In this case study, Conservative Ayurveda surgical management was followed in the case of diabetic foot gangrene. A 60 year old female patient, a known case of diabetes mellitus since three years presented with sudden onset of blackish discoloration, pus discharge in the left foot since two weeks. She was diagnosed as diabetic gangrene of left foot. She was advised amputation of foot by 3 contemporary surgeons. Patient had uncontrolled diabetes mellitus and sepsis, which was effectively managed. Once the patient was hemodynamically stable, amputation of left great toe and debridement of left foot ulcer was done. Following this treatment, extensive diabetic foot ulcer healed with formation of healthy granulation tissue with the help of internal medications and local wound care. Complete ulcer healing was noted in a span of four months without any complications, conservative Ayurveda Surgical intervention has proven very helpful to save the foot and complete healing of the ulcer in this case study.

Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion.

Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.

First clinical evaluation of the safety and efficacy of tarumase for the debridement of venous leg ulcers.

We report the first clinical evaluation of a new enzymatic wound debridement product containing tarumase in venous leg ulcer patients. As a first-in-human study, this was a prospective, open-label, multi-centre, dose escalation study across five dose cohorts and involving a total of 43 patients treated three times weekly for up to 4 weeks (12 applications). The primary and secondary endpoints of the study were to assess the systemic safety, local tolerability, and early proof of concept both for wound debridement and healing. Results indicated that the tarumase enzyme was well tolerated when applied topically to wounds, with no indications of systemic absorption, no evidence of antibody generation, and no systemic effects on coagulation pathways. Locally, there was no evidence of pain on application, no local itching, no increases in erythema, oedema, exudate or bleeding and only a few treatment emergent adverse events were reported. As the concentration of tarumase was escalated, trends towards faster and improved effectiveness of wound debridement were observed, especially in patients with significant slough at baseline. Trends towards faster rates of healing were also noted based on observations of increased granulation tissue, increased linear healing and reduction in surface area over the 4-week treatment period.

A Prospective, Open-Label, Nonrandomized Clinical Trial Using Polyvinyl Alcohol Antibacterial Foam for Debridement of Diabetic Foot Ulcers

Background. Diabetic foot ulcers (DFUs) pose significant challenges for patients, often leading to chronic inflammation, reduced mobility, and chronic pain. Despite being less prevalent in the United States compared to other nations, the economic burden of DFUs remains substantial, with an estimated annual cost ranging from $9 billion to $13 billion. Furthermore, DFUs are a leading cause of nontraumatic lower extremity amputations and significantly impact health care systems and work productivity. Objective. This study aimed to evaluate the effectiveness of a polyvinyl alcohol (PVA) foam dressing containing gentian violet/methylene blue (GV/MB) in managing chronic DFUs. Materials and Methods. A single-center study was conducted involving 20 patients with full-thickness chronic lower extremity wounds, including DFUs. Patients received treatment with a PVA foam dressing with GV/MB applied in an outpatient setting over a period of 4 weeks. Wound size, bacterial presence, and healing progress were assessed using fluorescence imaging and wound measurements. Results. The study included 13 males and 7 females with an average age of 64.2 years. After 4 weeks of treatment, the average DFU size decreased by 53%, with 4 patients achieving complete wound closure. Reduction in ulcer size was strongly correlated with the use of surgical debridement and PVA GV/MB foam. Fluorescence imaging demonstrated a significant reduction in bacterial presence in all patients by the end of the study. Follow-up at 3 and 6 months showed no recurrent ulcerations, indicating the potential for long-term efficacy. Conclusion. The findings suggest that PVA GV/MB foam dressings, when combined with surgical debridement, are effective in promoting the healing of chronic DFUs. Further research with larger, controlled studies is warranted to confirm these findings and assess cost-effectiveness.

Beauveria bassiana Keratitis: A Case Series and Review of Literature.

Beauveria bassiana is a filamentous fungus commonly used as an insecticide that rarely causes keratitis. Patients affected by Beauveria bassiana keratitis were retrospectively recruited at San Raffaele Hospital (Milan, Italy) between 2020 and 2022. All subjects underwent comprehensive ophthalmic evaluation, including in vivo confocal microscopy (IVCM) and microbiologic examination of corneal scrapings. Beauveria bassiana was identified using 18S rDNA targeted PCR. Four eyes of four patients (51 ± 8.8 years old) were evaluated. The main risk factors were soft contact lens wear (75%) and trauma with vegetative matter (50%). A superficial infiltrate was displayed in the majority of patients. Three cases (75%) showed hyphae on IVCM. All patients showed clinical improvement after topical antifungal therapy, although mostly through a combination of two antifungals (75%). One patient with a deeper infection required a systemic antifungal agent after one month of topical therapy. All cases required debridement to reduce the microbial load and enhance drug penetration. All patients experienced keratitis resolution following medical treatment (average: 3.3 months). The identification of risk factors and the early diagnosis of Beauveria bassiana keratitis are fundamental in order to avoid its penetration in the deeper corneal stromal layers. Topical antifungal drugs, possibly accompanied by ulcer debridement, may be a successful treatment if instilled from the early phases of the disease.

EFFICACY OF ULTRASONIC TRANSDERMAL PLATELET RICH PLASMA ON CHRONIC LOWER LIMB VENOUS ULCER HEALING

The present study was carried-out to examine the impact of Ultrasonic Transdermal Delivery of platelet rich plasma (PRP)on chronic lower limb venous ulcer healing. Design: Randomized controlled trial. Patients and methods: The present work was conducted on sixty patients with chronic lower limb venous ulcers who took-part in this study, they aged from 40 to 60 years. The participants were recruited from Mataria teaching hospital and were randomized into two groups; each group consisted of 30 patients. Group A (Ultrasonic PRP group) received Ultrasonic Transdermal Delivery of autologous PRP twice weekly for a month in addition to medical care and group B (Control group) received medical care in form of antimicrobial dressing, wound care and debridement of ulcers. Saline method was used to measure the ulcer volume. Digital photography/imaging and surface area estimation software (Image J) was used to measure ulcer surface area. Results: After treatment, there was significant decline in wound surface area as well as volume of PRP group in comparison with the control group (p &lt; 0.001). Conclusion: Adding Ultrasonic transdermal delivery of platelets rich plasma to medical treatment of chronic venous ulcer can enhance healing process by reducing surface area and ulcer volume and it is considered a safe, simple, inexpensive and cost effective modality.

Modified ulcer debridement versus argon laser photocoagulation as an adjunctive therapy for treatment of fungal keratitis

Abstract Background Mycotic keratitis is a disorder due to fungal invasion into the corneal stroma. Early diagnosis and immediate management are critical to avoiding long-term consequences with fungal keratitis as it grows quickly and can cause corneal ulcers and vision loss. Aim To compare the effect of argon laser photocoagulation with tissue debridement as a supportive therapy for treatment of fungal keratitis. Patients and methods In this prospective study, 40 patients with resistant fungal keratitis were evaluated and treated with argon laser and debridement as a supportive therapy in resistant cases.The duration of the study was 12 months with follow-up period of 3 months. Results Of 20 eyes, 18 responded to argon laser with complete epithelial healing occurring in the range of 2–4 weeks, with mean of 47.50 ± 7.96 weeks. On the contrary, 16 of 20 eyes responded to debridement, with complete healing occurring in the range of 3–7 weeks, with a mean of 46.15 ± 7.57 weeks. Two cases needed amniotic membrane graft in the laser group, whereas four cases in the debridement group. Conclusion Argon laser therapy is the most effective supplementary step in the treatment of resistant fungal keratitis. Argon laser therapy is preferred to debridement in the management of resistant fungal corneal ulcer and has a significant effect on reducing corneal scarring and improvement of visual acuity.

Response to the Letter to the Editor "Methylene Blue Staining and Ultrasonic Debridement: A Superior Therapeutic Strategy for Pressure Ulcer Debridement".

Response to the Letter to the Editor "Methylene Blue Staining and Ultrasonic Debridement: A Superior Therapeutic Strategy for Pressure Ulcer Debridement".

Letter to Editor Regarding "Methylene Blue Staining and Ultrasonic Debridement: A Superior Therapeutic Strategy for Pressure Ulcer Debridement".

The treatment of pressure ulcer is of an extreme clinical and social concern. Effective and thorough debridement lays the foundation for favorable wound healing. Recently, a case report confirmed the efficacy of a combined application of methylene blue staining and ultrasonic debridement for pressure ulcer debridement. A 91-year-old male who suffered from severe pressure ulcers for over 6 years eventually obtained a favorable restoration after receiving surgical debridement optimized with methylene blue staining and ultrasonic debridement. We write to learn more about the details of the case. In this letter, we raised some questions involving the identification capability of methylene blue staining among different tissues, the application of methylene blue staining for various wounds, the arrangement of the debridement liquid, and the management strategy after wound closure. We thank the authors for creating a successful paradigm and hope the discussion can make sense for guiding subsequent clinical practice.

The DEFINITE Audit: a prospective audit of diabetic foot debridement in theatre – a protocol

Background: People with diabetes are commonly affected by foot ulceration (DFU) and subsequent or concurrent infection (DFI). Surgical debridement is often needed to contain infection. Despite international guidelines, there remains significant variation in surgical practice of diabetic foot wound debridement in the operating theatre. Methods: Diabetic Foot Ulcer Debridement in Theatre Audit (DEFINITE) is a global multicentre, prospective audit of consecutive patients undergoing a debridement or minor amputation in theatre for a diabetic foot complication. DEFINITE is led by the Vascular and Endovascular Research Network (VERN). The primary outcome is adherence to recommended practice as outlined in the International Working Group on the Diabetic Foot and Global Vascular Guidelines. Secondary outcomes are incidence of healing, re-admission, further amputation (minor and major) and mortality at 90 days. Anonymised data will be collected via REDCap. Eligibility and study registration at all hospital institutions performing in-theatre management of diabetic foot complications are eligible to participate after obtaining appropriate institutional level audit approvals. A lead clinician will be responsible for approvals and data management. Pathway to impact: This audit addresses shared patient-clinician priorities and is supported by the UK Vascular Society multidisciplinary Special Interest Group on the Diabetic Foot. The results will be presented at international scientific meetings and submitted for publication in peer-reviewed publications. The results will also be used to initiate improvement in patient care.

Limb Salvage using Maggot Debridement Therapy on a Diabetic Foot Ulcer Complicated by Gas Gangrene

Maggot debridement therapy (MDT) has resurfaced three decades ago as a result of the steep rise in the emergence of antibiotic resistant strains of pathogenic bacteria and the need for an effective non-surgical method for wound debridement in the critically ill patients. This case study reports on the successful use of MDT to salvage the limb of the index patient who was booked for above knee amputation. The patient is a 53-year-old lady who presented with left foot ulcer of six weeks' duration to our facility. Sterile first instar larvae of L. sericata obtained from an indigenous company (Biosurg wound care Nigeria Limited) were applied using the confinement (free-ranged) method. Staphylococcus epidermidis and Pseudomonas fluorescens were isolated before the application of MDT. However, after the application, the wounds m/c/s yielded no growth. Rapid epithelization and increased vascularity of the tissues were observed in the patient after the application. Maggot debridement therapy was successfully used in the debridement of diabetic foot ulcer complicated by gas gangrene in Nigeria for the first time and the clinical outcome is encouraging.

Secondary Autologous Fat Grafting for the Treatment of Chin Necrosis as a Consequence of Prone Position in COVID-19 Patients.

Due to the spread of the coronavirus disease 2019 pandemic, an increasing number of ill patients have been admitted to intensive care unit requiring mechanical ventilation. Although prone positioning is considered beneficial, long periods in this position may induce important complications, including pressure ulcers in high-risk and uncommon body areas. We report five cases of pressure ulcer necrosis of the chin in coronavirus disease 2019 patients as a consequence of mechanical ventilation in prone positioning using autologous fat grafting (AFG) as a secondary technique. A series of five patients with secondarily-healed chin necrosis treated by AFG between February and June 2020 were reviewed. All patients had been treated initially with surgical debridement followed by conservative treatment. Secondary AFG was performed to reduce patient's pain, improve chin contour-projection, and minimize cosmetic sequelae and scarring. Patient satisfaction was assessed using a five-point Likert scale (0-4). Vancouver scale was used to evaluate the chin scars clinically. The average amount of fat injected into the chin area was 8.1 ± 2.0 ml. At 6-month follow-up, all patients were mostly satisfied (average Likert-scale 3.2 ± 0.4). Based on the Vancouver scale, improvement of the chin scar from 9.5 ± 0.8 to 4.7 ± 0.8 was found. We report a positive experience with secondary AFG for correction of painful and unaesthetic scarring and contour abnormality following surgical debridement and secondary-intention healing of chin pressure ulcers.

Study on the protective mechanism of dexmedetomidine on the liver of perioperative diabetic patients: A randomized controlled trial.

Background:Although several studies have reported that dexmedetomidine is a highly selective α2-adrenergic receptor agonist that protects liver function in perioperative patients by inhibiting oxidative stress (OS) and inflammatory response, patients with type 2 diabetes mellitus (T2DM) have not been included in the previous studies. The purpose of this study was to investigate the effects of perioperative low-dose dexmedetomidine on perioperative liver function in T2DM patients.Methods:This was a single-center, placebo-controlled randomized trial. Fifty-four T2DM patients scheduled for debridement of lower extremity ulcers were included in this study and randomly divided into 2 groups (n = 27 per group): the dexmedetomidine group (DEX group) and the control group (CON group). Continuous intravenous infusion of dexmedetomidine (DEX group) or normal saline (CON group) was administered from the completion of monitoring to the end of surgery. All participants received femoral and sciatic nerve block with 0.33% ropivacaine. The main result was the activity of liver enzymes (AST, ALT) reflecting liver function. The secondary results included variables reflecting blood glucose (Glu), blood lipids (TG, HDL, LDL, total cholesterol), biomarkers of OS (MDA, SOD), and systemic inflammatory response (TNF-α, IL-6).Results:Compared with CON group, DEX group exhibited a reduction in hemodynamic parameters, Glu, systemic inflammatory response, and liver injury indicators. OS response MDA activity was lower in DEX group than in CON group, while SOD was higher than that in CON group. The variables reflecting lipid metabolism function showed no differences between the groups.Conclusion subsections:Dexmedetomidine administered perioperatively can reduce Glu levels and protect the liver by attenuating OS injury and inflammatory response in T2DM patients without any potential risk.

Calcific uremic arteriolopathy in a young man on intermittent hemodialysis

A 42‐year‐old man with ESKD who has been on intermittent hemodialysis for 7 years, presented with extremely painful inguinal ulcer and abdominal mass. The lesion was developed 2 weeks after repairing aneurysmal cubital AVF. At first, it was a small and painful red nodule but then its size increased and a large ulcer was developed. In addition, the physical examination revealed a palpable and painful large mass at left lower side of abdominal wall. He did not have important risk factors such as diabetes mellitus, treatment with warfarin, and use of calcium containing phosphate binders, vitamin D or calcium supplements. The patient suffered a long standing and severe secondary hyperparathyroidism. The parathyroid hormone level was too high (3100 pg/ml). In addition, serum calcium and phosphorus levels were 9.4 mg/dl and 9.8 mg/dl respectively. The SPECT-CT scan with 99 m Tc-MIBI of parathyroid glands confirmed persistence of an adenoma in right lower parathyroid gland (Figure 1, green arrow). The BMI was 32 kg/m2. He had no adherence to use of phosphate binder or calcimimetic drugs. The radiological studies showed extensive microvascular calcification in soft tissues (Figure 1, small arrow) and osteitis fibrosa cystica in long bones (Figure 1, star). The patient underwent surgical debridement of ulcer and palpable abdominal mass, wound care, intensive dialysis therapy with low calcium dialysis bath, cinacalcet, sevelamer carbonate, antibiotic and analgesic therapy. The histological sample (H&amp;E, 200X) shows Intramural calcification and obliteration of arteriole (large arrow) with extensive calcification in fat tissue (Figure 1, arrow head) which was consistent with Calcific Uremic Arteriolopathy (CUA). In addition to patient’s poor compliance to treatment of severe secondary hyperparathyroidism, the recent surgery of aneurismal AVF could also be an important trigger to development of calcific uremic arteriolopathy.

Automated Identification of Clinical Procedures in Free-Text Electronic Clinical Records with a Low-Code Named Entity Recognition Workflow.

Clinical procedures are often performed in outpatient clinics without prior scheduling at the administrative level, and documentation of the procedure often occurs solely in free-text clinical electronic notes. Natural language processing (NLP), particularly named entity recognition (NER), may provide a solution to extracting procedure data from free-text electronic notes. Free-text notes from outpatient ophthalmology visits were collected from the electronic clinical records at a single institution over 3 months. The Prodigy low-code annotation tool was used to create an annotation dataset and train a custom NER model for clinical procedures. Clinical procedures were extracted from the entire set of clinical notes. There were a total of 5,098 clinic notes extracted for the study period; 1,923 clinic notes were used to build the NER model, which included a total of 231 manual annotations. The NER model achieved an F-score of 0.767, a precision of 0.810, and a recall of 0.729. The most common procedures performed included intravitreal injections of therapeutic substances, removal of corneal foreign bodies, and epithelial debridement of corneal ulcers. The use of a low-code annotation software tool allows the rapid creation of a custom annotation dataset to train a NER model to identify clinical procedures stored in free-text electronic clinical notes. This enables clinicians to rapidly gather previously unidentified procedural data for quality improvement and auditing purposes. Low-code annotation tools may reduce time and coding barriers to clinician participation in NLP research.