Ulcer Severity Score Research Articles

Clinical utility of diabetic ulcer severity score in patients with diabetic foot ulcers – A prospective study

Background: The most common reason for hospitalisation for diabetic people is diabetic foot ulcer (DFU). For diabetic foot ulcers, a variety of scoring systems and classifications are available with the goal of comparing treatment options and long-term results. Aim of the study was to evaluate the effectiveness of the diabetic ulcer severity score, a wound-based clinical scoring system for diabetic foot ulcers, in predicting clinical outcomes. Materials and method: A prospective study was conducted on 65 diabetic ulcer patients. DUSS was applied during the admission. The DUSS consists of four clinical variables: 1) pedal pulses, 2) bone probing, 3) ulcer site, and 4) ulcer number. These wounds were scored as 0, 1, 2, 3, or 4. All patients received standard care in accordance with a protocol. The outcome of treatment was recorded. Results: In this prospective study of 65 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean duration of diabetes was 8.13±4.28 years. Most commonly ulcers were of DUSS score 1. Of the 65 patients, 36 (55.38%) got conservative care, including wound debridement, 14 (21.54%) underwent skin grafting, and 15 (23.08%) underwent amputation. DFU with DUSS score 0 healed by 2 weeks, score 3 and 4 healed mostly only after surgical intervention. Comparison of amputation based on DUSS score showed statistical significance. The mean healing time was found to be 108.8±43.7 days. Conclusion: This study conclude that DUSS system is a wound based diagnostic procedure to predict healing, amputation or need for surgery by combining the four sign in a safe manner. Keywords: amputation; diabetes mellitus; duss scoring system; foot ulcer

Індекс системного імунного запалення як корисний інструмент для прогнозування хронічного афтозного стоматиту

Relevance. Chronic recurrent aphthous stomatitis (RAS) is one of the most common chronic inflammatory diseases of the oral cavity, which affects approximately 5 to 25% of the population. RAS is a multifactorial disorder, and studies have pointed to several potential causes associated with its occurrence. The aim is to analyse the role of inflammatory markers in the development of chronic recurrent aphthous stomatitis. Materials and methods. The study involved 80 patients: 29 men (36.25%) and 51 women (63.75%) with RAS who sought help at the Department of Therapeutic Dentistry of the Bogomolets National Medical University. The ulcer severity score (USS) was used to assess and monitor the ulcers according to 6 clinical characteristics: number of ulcers, size of ulcers, duration of ulcers, period without ulcers, pain and location of ulcers. NLR, PLR and SII values were calculated from the results of a complete blood count. The measurements were compared statistically using SPSS software (version 23.0 for Windows). Study results and discussion. The mean USS score was 35.8±7.78 in patients with RAS. NLR values were significantly higher in patients with RAS than in the control group (3.59 ± 2.9 vs. 1.76 ± 2.4, p < 0.001). The values of SII and PLR were statistically higher in patients with RAS compared with the control group (SII, 606.0 ± 2.9 vs. 409.8 ± 2.1 kl/l, p < 0.001; PLR, 192.3 ± 1.9 vs. 105.9 ± 0.96, p = 0.01). Conclusions. NLR, SII, PLR are cheap and simple biomarkers that can be used as markers of inflammation or severity of inflammation in patients with RAS. Key words: chronic aphthous stomatitis, blood, neutrophils, leukocytes, platelets, inflammation, systemic immune inflammation index.

Anti-ulcer activity of aqueous ethanol extract of Rheum spiciforme and its fractions in animal model

Helicobacter pylori infection, pepsin, ischemia, hypoxia, smoking, alcohol intake, hydrochloric acid, and nonsteroidal anti-inflammatory drugs are the causal factors of ulceration. In third-world countries, approximately one in two individuals has signs of gastric ulceration. Extensive literature suggested that plant-derived drugs hold the potential in the treatment of peptic ulcer, and Rheum spiciforme (family: Polygonaceae) has been known in the folk medicine for possessing medicinal effect on ulceration. To explore further along this line, the current study was designed to investigate the effects of aqueous ethanol extract of R. spiciforme roots and its fractions on peptic ulcer and to identify bioactive compounds responsible for mitigating this pathological condition. Animal model of ethanol-induced gastric ulcer was utilized in this study. The animals were pre-treated with crude plant extract, given at doses 125, 250, and 500 mg/kg, and then orally administered with butanol, aqueous, and dichloromethane fractions at doses of 250 mg/kg for 7 days. Following the treatments, a significant decrease in ulcerative lesions, ulcer index, ulcer severity score, volume, free acidity, and total acidity of gastric juice as well as a marked increase of gastric pH in the groups treated with plant extract at doses of 250 and 500 mg/kg were noted. Moreover, butanol fraction has been shown to produce effects equipotent to that of the reference drug omeprazole. Liquid chromatography-mass spectrometry analyses show that the plant extract contains emodin, aloe-emodin, and quercetin. In conclusion, this study demonstrated that the aqueous ethanol extract of R. spiciforme and its butanol fraction exhibited gastro-protective effect.

Topical betamethasone and systemic colchicine for treatment of recurrent aphthous stomatitis: a randomised clinical trial

BackgroundRecurrent Aphthous Stomatitis (RAS) is painful oral ulceration frequently treated with topical steroids. There is limited published evidence for the efficacy of any treatment for RAS and there remains a need for longitudinal randomised clinical trials to evaluate and compare the effectiveness of different therapies in the management of RAS. The aim of the current project was to assess the efficacy of betamethasone mouthwash and colchicine tablets, individually and combined, for the treatment of RAS, and to establish the optimum treatment period necessary for a significant reduction in the disease severity.MethodologyA randomised, prospective, parallel-group clinical trial was conducted over one year, to compare the efficacy of three therapies in RAS. One hundred and six patients were randomized into three groups; 35 received betamethasone mouthwash, 35 had colchicine tablets and 36 received both therapies. The response was evaluated quantitatively every 3 months for 1 year, using the Ulcer Severity Score (USS).ResultsFor all three treatment regimes, the mean USS decreased by about 30% in the first 3 months (p < 0.001). Further improvement was noted for up to 9 months. At the end of the study, the mean USS had improved by 50% from 34.9 ± 7.2 before treatment to 17.5 ± 8.9 after treatment (p < 0.001). Of included participants, 86% showed significant clinical improvement by the end of the study. There were no significant differences in outcomes between the three regimes (p < 0.05).ConclusionsThis clinical trial has provided evidence for the efficacy of betamethasone mouthwash and for colchicine tablets in the treatment of RAS and has shown that at least six months of treatment may be required for optimum effect.Clinical trial registration number:ISRCTN3267716. Date of clinical trial registration: 15/04/2018

Comparison of Effectiveness of Hiora SG Gel With Triamcinolone Acetonide Gel in Recurrent Aphthous Stomatitis.

Background The oral condition known as recurrent aphthous ulceration (RAU) or recurrent aphthous stomatitis (RAS) is very prevalent. Its etiopathogenesis is unknown; hence, symptomatic therapy is all that can be offered if it manifests clinically. Lesion care aims to minimize discomfort and the frequency of relapses by bringing active illness under local control in the affected area. The current treatment options that may have negative side effects include the use of topical and systemic steroids, antibiotics, cauterization, and laser therapy. Objectives and Importance This study aimed to compare the efficiency of HiOra SG gel with triamcinolone acetonide gel in the management of RAS. Materials and Methods Fifty individuals with RAS were recruited for the trial and randomly assigned to either group I (HiOra SG gel) or group II (0.1% triamcinolone acetonide ointment; Oraways). After each meal for a total of 10 days, those with mouth ulcers were instructed to topically administer the drugs. The clinical data were analyzed by comparing the ulcer severity scores from the first, fifth, and 10th days. Results There was a statistically significant (p = 0.001) reduction in reported pain, pain duration, and overall ulcer severity across all groups. After therapy, however, neither the HiOra gel group nor the triamcinolone group showed any discernible improvement over the other. Conclusion The present study's findings corroborate the efficacy of HiOra SG gel in the treatment of RAS when compared to triamcinolone acetonide gel (0.1%). In this trial, no patients had any negative reactions to HiOra SG gel. In the future, further studies are needed with larger samples to prove its benefits.

A Study to Evaluate the Validity of Diabetic Ulcer Severity Score in Predicting Outcome of patients with Diabetic Foot Ulcer

Aim: To evaluate the validity of Diabetic Ulcer Severity Score in predicting the outcome of patients with Diabetic Foot Ulcer&#x0D; Methods: The materials used in the study consisted of 150 patients with Diabetic Foot Ulcer were admitted in department of General Surgery in Government Mohan Kumaramangalam Medical College and Hospital, Salem during January 2021 and October 2022.&#x0D; Results: Most of the diabetic ulcers were scored with DUSS Score of 2 and 1. Almost 80 out of 150 people had amputations in this study. Amputations were more common in patients with DUSS score 4 followed by 3. Major amputations were common in diabetic ulcers with DUSS score 4 and no patients with score 0 and 1 had major amputation. Minor amputations were more common in diabetic ulcers with DUSS score of 2. The probability of healing without amputation with score 0 was 100% and decreases to 17.3%% with score 3 and 0% with score 4.&#x0D; Conclusion: DUSS scoring system delivers an easy diagnostic tool for assessing need for surgery and expectation of probability of healing/amputation by combining four clinically assessable wound based parameters. This is a simple and easy scoring system which does not need advanced investigations and can be easily followed.

A comparative study between Wagner’s classification and new wound based diabetic foot ulcer severity score

Background: Diabetes is considered to be one of the most common health problems all over the world in 21st century. In fact, it has been coined the ‘Black death of the 21st century due to its stark similarities with the 14th century plague in terms of rapid increase in its prevalence, morbidity and mortality. According to WHO, the number of diabetic patients in 2000 reached to 171 million and was predicted to increase to 380 million by 2020. The Indian diabetic population is expected to increase to 57 million by the year 2025. Diabetic foot ulcers are one of the most distressing complications of diabetes affecting around 15% of people with diabetes. The annual incidence of diabetic foot ulcers is around 3% and the reported incidence in U.S and U.K studies ranges as high as 10%. It has been reported that 85% of the lower limb amputations in diabetic patients are preceded by foot ulceration. These systems are variously based on the site of ulcer, depth, and presence or absence of neuropathy, infection and peripheral arterial disease and have been used to compare the outcomes. Diabetic ulcer severity score (DUSS) is one of the latest wound-based systems of classification. However, there is paucity of enough data to validate whether DUSS system is better as compared to other established and commonly used scoring system like Wagner’s classification. Hence, it was decided to validate DUSS scoring system with Wagner’s classification by comparing both keeping in view outcome of the disease. Methods: Patients admitted under various surgical units from January 2022-January 2023, at Mamata medical college and hospital, Khammam. Total of 40 diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the hospital (Mamata general hospital) were recruited into the study based on the inclusion and exclusion criteria mentioned below. Results: DUSS score and Wagner’s score were found to be almost equal in evaluating the scores for treatment as p value was found to be statistically significant (p=0.001) and by KAPPA stats there was an absolute agreement (score 1) between DUSS and Wagner’s scoring system. Conclusions: The new severity scoring system (DUSS) is equal to gold standard Wagner’s scoring system for predictive analysis which also provides an early idea regarding hospital admission, local surgery and health care costs. Since this scoring system 72 can be easily applied in daily clinical practice, it may be suitable in estimating putative healthcare costs.

Evaluation of Diabetic Ulcer Severity Score (DUSS) in Predicting Outcome in Patients with Diabetic Foot Ulcer

Evaluation of Diabetic Ulcer Severity Score (DUSS) in Predicting Outcome in Patients with Diabetic Foot Ulcer

Factors associated with health-related quality of life of south indian population with chronic venous leg ulcers - A hospital based pilot study

ObjectiveVenous leg ulcers (VLU) are chronic, recurrent and have a significant impact on the patients’ health- related quality of life (HRQoL). This study assessed the association of patient-specific factors on the HRQoL of patients with chronic venous leg ulcers. Materials and MethodsThe study included 21 males and 21 females aged 18 years and above, with chronic VLU. Data on demographics, education, occupation, per capita income, duration of ulcer were subjectively recorded. The socio-economic status was scored based on the Modified Kuppuswamy scale 2019, ulcer severity was assessed using M.A.I.D. Scale and the HRQoL of the patients were assessed using the 36-Item Short-Form Health Survey Version 1.0. The differences in the mean HRQoL scores between patients based on their gender and socio-economic class were assessed using an unpaired sample t-test. The association of age, severity, duration of the ulcer with the HRQoL were assessed using Pearson's correlation. A probability value of < 0.05 was considered statistically significant. ResultsThere were 21 (50%) males and 21 (50%) females with a mean age of 55.45 ± 7.73 years. The mean duration of ulcers was 7.26 ± 3.34 months and the mean ulcer severity score was 2.16 ± 0.96. Role limitations due to the physical health were found to be most impacted due to the disease condition with the least mean score of 26.78 ± 31.90 %. There were no significant differences in the mean scores of the physical and the mental components of HRQoL based on gender but there were significant differences based on socio-economic status. The lower the socio-economic status, the poorer the HRQoL. Age, severity of ulcers and ulcer duration had a significant negative correlation with HRQoL. ConclusionThe study observed a low HRQoL of patients in physical aspects reflecting on the extensive limitation on the performance of daily physical activities. Patient-specific factors such as age, socio-economic status, severity, and chronicity of ulcers were found to influence HRQoL.

Antioxidant and Gastroprotective Activity of Suaeda fruticosa Forssk. Ex J.F.Gmel.

Suaeda fruticosa Forssk. Ex J.F.Gmel is traditionally used for inflammatory and digestive disorders, as a carminative, and for diarrhea. This plant is widely distributed in Asia, Africa, and the Mediterranean region. Aqueous methanolic extract of S. fruticosa (Sf.Cr) was prepared and screened for phytoconstituents through qualitative and GC-MS analysis. Quantification of total phenolic and flavonoid contents was performed, while antioxidant capacity was determined by DPPH, CUPRAC, FRAP, and ABTS assays. The gastroprotective activity was assessed in an ethanol-induced ulcer model. Gastric secretory parameters and macroscopic ulcerated lesions were analyzed and scored for ulcer severity. After scoring, histopathology was performed, and gastric mucus contents were determined. Oral pre-treatment of Sf.Cr demonstrated significant gastroprotection. The gastric ulcer severity score and ulcer index were reduced while the %-inhibition of ulcer was increased dose-dependently. The Sf.Cr significantly elevated the pH of gastric juice, while a decrease in total acidity and gastric juice volume was observed. Histopathology demonstrated less oedema and neutrophil infiltration in gastric mucosa of rats pre-treated with the Sf.Cr in comparison to ethanol-intoxicated animals. Furthermore, the gastric mucus contents were increased as determined by alcian blue binding. Sf.Cr showed marked gastroprotective activity, which can be attributed to antioxidant, antisecretory, and cytoprotective effects.

The correlation of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with disease severity in recurrent aphthous stomatitis.

To evaluate the correlation of systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with disease severity in recurrent aphthous stomatitis (RAS). The present retrospective cohort study was performed on patients with RAS. Patients were divided into three groups: 1) Major (n=75), 2) Minor (n=123), and 3) Herpetiform aphthae (n=17). The study groups were compared in terms of demographic features, acute phase proteins, and complete blood cell count parameters. Moreover, correlation analyses were performed for the correlation of ulcer severity score (USS) with C-reactive protein (CRP), SII, erythrocyte sedimentation rate (ESR), ferritin, dNLR, NLR, and PLR. Significantly higher values were observed for USS, neutrophil count, ferritin, SII, NLR, and dNLR (p<0.05 for all) in the major and herpetiform aphthae groups compared to the minor aphthae group. Positive, strong, significant correlations were observed between USS, SII, and NLR (r=0.80 for SII, r=0.74 for NLR and p<0.001 for both). Positive, moderate, significant correlations were observed between USS, PLR, ESR, and CRP (r=0.54 for PLR, r=0.39 for ESR, r=0.36 for CRP, and p<0.001 for all). Positive, weak, significant correlations were observed between USS, dNLR, and ferritin (r=0.13 and p=0.05 for ferritin, r=0.27 and p<0.001 for dNLR). Higher values of SII, NLR, dNLR, and PLR were associated with disease severity in patients with RAS.

A prospective observation study on diabetic foot ulcer using diabetic ulcer severity score at tertiary care hospital

Background: A number of scoring systems and classifications are available for diabetic foot ulcers with intention to compare the treatment modalities and future outcomes. Many of them are complex and don’t predict future outcome within the patients. Aim and objectives of current study were to establish a wound-based clinical scoring systems (DUSS) as daily clinical practice by assessing the efficacy of diabetic ulcer severity score.Methods: A total of 73 diabetic patients with foot ulcers were included in this prospective observational study conducted at Dr. S.N. Medical college, Jodhpur and attached hospitals from July 2018 to August 2020. Ulcers were assessed and DUSS score created. Patients were followed up for six months or until healing or amputation if either.Results: In this prospective study of 73 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean age group was 58.57±12.66 years. Mean duration of diabetes was 7.61±5.72 years. Most commonly ulcers were of DUSS score 2. Mean DUSS score was 1.97±1.15. Majority of diabetic foot ulcer patients (37 out of 51) with DUSS score 0, 1 and 2 healed by primary intention after wound debridement. Those with score 3 &amp; 4 majority of them (20 out of 22) had amputation.Conclusions: This is a very simple scoring system that provides an easily accessible and a streamlined approach in the clinical setting without need of any advanced investigative equipment. Hence this can be applied in any set up.

Efficacy of diabetic ulcer severity score in patients with diabetic foot ulcer in predicting prognosis

Background: Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced by peripheral neuropathy or peripheral arterial disease in patients with diabetes. There are well-accepted classification systems for DFUs, namely Wagner’s scoring system, university of Texas scoring system etc. However, only few are scientifically validated. Diabetic ulcer severity score (DUSS) introduced by Beckert et al consists of easily accessible clinical parameters which categorizes wounds into specific subgroups for comparison of outcomes.Methods: A prospective study was conducted on 250 diabetic ulcer patients, attending the out-patient department (OPD) of surgery, Pushpagiri institute of medical sciences, Tiruvalla.Results: Most common age group affected with diabetic foot was between 51-60 years (mean 58.9±10.2 years). Males accounted for 54% of patients. Most common ulcers were of score of 2 followed by score 3. Overall, 105 (42%) of 250 people had amputations in our study with majority undergoing minor amputation (30%) than the major amputation (12%). None of the patients with scores 0, 1 and 2 had major amputation. Probability of healing among the various scores were-100% for score 0, 97.9% for score 1, 83.4% for score 2, 17.7% for score 3 and 4.8% for score 4. Lower score is strongly associated with primary healing and higher score with amputations.Conclusions: DUSS system is an easy wound based diagnostic tool for anticipating probability of healing or amputation and need for surgery by assessing the four clinical parameters and combining them which is safe and easily reproducible.

Effects of eye patches on corneal ulcer healing and weight gain in stocker steers on pasture: a randomized controlled trial.

Infectious bovine keratoconjunctivitis (IBK) is a painful ocular disease in cattle that is characterized by the presence of a corneal ulcer and production losses. A common industry practice is to cover an affected eye with a piece of cloth to reduce exposure to face flies and ultraviolet light with the goal of alleviating pain, accelerating healing, and reducing spread. To study the efficacy of eye patches in the treatment of IBK, a group of 216 clinically normal Angus crossbred steers were followed between April and August 2019 and evaluated weekly for the development of IBK. Eyes of cattle that developed IBK were enrolled with a blocked randomization scheme based on ulcer severity score to receive either an eye patch (treatment group) or no eye patch (control group). All treatment and control group animals received parenteral antimicrobial and nonsteroidal anti-inflammatory treatments and were housed in a pasture separated from the rest of the cohort for a maximum of 28 d or until clinical cure. Corneal ulcer areas were measured, and body weights were recorded twice weekly for steers in the treatment and control groups. Weights of all steers in the cohort were recorded three times during the trial period. The primary outcome, rate of corneal ulcer healing, was higher (P = 0.001) for lesions in eyes receiving an eye patch as determined by a linear mixed model that controlled for ulcer severity score at enrollment and previous IBK in the opposite eye. Median corneal ulcer healing time was 10 (IQR [Interquartile range] 7–17) d for patched eyes vs. 14 (IQR 7–21) d for unpatched eyes. In a Cox proportional hazards model adjusted for severity score at diagnosis, the hazard ratio for ulcer healing was 1.62 (95% CI: 1.02–2.56, P = 0.042) for eyes that received a patch compared to eyes that did not. Among all 216 steers in the cohort, those that were diagnosed with IBK had a numerically higher average daily gain (ADG) (0.45 [±SE 0.01] kg) vs. those that were not (0.42 [±SE 0.12] kg; P = 0.06). In enrolled steers that received a patch, the secondary outcome ADG was 0.47 (±SE 0.02) kg compared to 0.43 (±SE 0.02) kg in controls (P = 0.22). Weight gain may have been confounded by pasture during the treatment period. Results of this trial support the use of this low-cost intervention; further investigation into possible reasons for observed differences in weight gain may be warranted.

54 Evaluation of gastric health in cribbing horses fed a digestive support supplement

Cribbing is a stereotypic oral behavior whereby the horse places its incisors on a fixed object, arches its neck, pulls against the object, and emits an audible grunt. Cribbing behavior (CB) has been associated with gastrointestinal (GI) dysfunction and gastric ulceration. This randomized crossover study tested the hypothesis that dietary inclusion of a commercially available equine GI support supplement (Legends Gastrocare, Cargill, Wayzata, MN) would alter the GI environment and gastric ulcer severity in normal and cribbing horses. Mature Quarter Horses with CB (n = 4) and sex-matched non-cribbing controls (NCB; n = 4) were randomly assigned to receive either a GI support supplement (TRT) or placebo for 21 d, followed by a 2-wk washout period. Treatment groups were then switched and horses were treated for an additional 21 d. Before and after each treatment period, gastric and fecal pH were measured, and gastric ulcer severity was evaluated via endoscopic examination using an established grading system for squamous (0–4) and glandular gastric ulceration (0–1). Horses were acclimated for 2 wk before the start of the study, and throughout the study were individually stalled 16 h/d and fed bermudagrass hay (1.2% BW, DM basis) and concentrate (0.5% BW) and turned out in pairs in paddocks 8 h/d. Data were analyzed by mixed-model ANOVA with treatment, cribbing status (CB or NCB) and period included as fixed effects, and horse as a random effect. Data are presented as means ± SD. Fecal pH (6.5 ± 0.1) and gastric pH (2.9 ± 0.5) were similar between CB and NCB horses and were unaffected by TRT. Squamous mucosa ulcer scores did not differ between CB and NCB, and were unaffected by TRT. However, within CB horses, squamous ulcer severity scores were greater (indicating more severe ulceration) ( P = 0.003) with TRT (3.9 ± 0.6) than placebo (1.4 ± 0.3). Based on this pilot study, administration of a commercial GI support supplement did not alter gastric or fecal pH in normal or CB horses. Ongoing serum cortisol, serum gastrin, and microbiome analyses may help to explain the differences in gastric ulceration severity noted in CB horses when receiving TRT versus placebo. Collectively, these findings add to the growing body of literature regarding GI environment and pathophysiology in horses exhibiting CB.

Effect of Omega-3 on Recurrent Aphthous Stomatitis and Improvement Quality of Life.

Objective Recurrent aphthous stomatitis is one of the most common chronic inflammatory diseases in oral mucosa. Beneficial effects of omega-3 supplements on some inflammatory diseases have been proved. The aim of present study was to evaluate the effect of omega-3 supplements in recurrent aphthous stomatitis management and improve oral health-related quality of life. Methods In this double-blind clinical trial, 40 patients with minor recurrent aphthous stomatitis were randomly divided into case and control groups. The case group received 1000 mg capsules of omega-3, while the control group received placebo capsules for 6 months. The questionnaires of the ulcer severity score and the chronic oral mucosal disease questionnaire were filled by the patients in three steps, at the baseline session, after 3 months, and after 6 months. The data were analyzed by SPSS 22 software through ANOVA, Mann–Whitney, and chi-square tests. P < 0.05 was considered as significant. Results In the omega-3 group, the ulcer severity score showed significant reduction by three-month and six-month follow-ups (P < 0.0001, P < 0.0001, respectively). The mean score of the chronic oral mucosal disease questionnaire significantly improved by three-month and six-month follow-ups in the omega-3-receiving group. Conclusion Use of omega-3 oral supplements decreased the severity of aphthous ulcer and improved oral health-related quality of life.

Prospective study of Diabetic foot Ulcer outcomes using Diabetic Ulcer Severity Score (DUSS)

Prospective study of Diabetic foot Ulcer outcomes using Diabetic Ulcer Severity Score (DUSS)

Effects of supplements containing turmeric and devil’s claw on equine gastric ulcer scores and gastric juice pH

SummarySupplements containing turmeric (Curcuma longa) and devil’s claw (Harpagophytum species) are commonly fed to horses to decrease inflammation and pain, but because these supplements contain spices and plant irritants, warning labels such as 'these supplements might cause gastric irritation' are required. The purpose of this study was to determine whether supplements containing turmeric and devil’s claw cause or worsen gastric ulcers in stall‐confined horses, as suggested in required cautions that appear on the labels of these animal products. Twelve clinically healthy Thoroughbred horses with naturally occurring equine gastric ulcer syndrome (EGUS) scores &gt;0 were included in a noncrossover study design. Horses were stratified by EGUS score and assigned to either the treatment (supplements containing turmeric and devil’s claw) or control (same supplements without active ingredients) group and fed the supplements for 28 days. Gastroscopy was performed on Days 0, 14 and 28. The EGUS score, nonglandular ulcer number (NGN) and severity (NGS) scores, and glandular number (GN) and severity (GS) scores were recorded during each gastroscopy by a masked investigator (F.M.A.). In addition, bodyweight, gastric juice pH, packed cell volume (PCV), total protein (TP) and blood biochemical results were measured on Day 0 and Day 28. Mean EGUS and NGS scores were significantly lower in both treatment and control groups by Days 14 and 28, when compared to Day 0. NGN score was not different among groups. Bodyweight, gastric juice pH and blood parameters did not change during the study. In conclusion, supplements containing turmeric and devil’s claw did not cause or worsen gastric ulcers or alter health parameters after 28 days of feeding.

New mouthwash: an efficacious intervention for oral ulceration associated with Behçet's disease

Topical interventions to treat oral ulcers in Behçet's disease (BD) are crucial to control disease activity and improve patients' quality of life. Our aim was to evaluate the effectiveness of a new BD mouthwash (BD MW) for oral ulceration. A retrospective cross-sectional study was carried out on 261 BD patients (141 women, mean (SD) age 39.9 (11.8) years, and 120 men, mean (SD) age 41.141(3.7) years). All were assessed using the oral ulcer severity score (OUSS), oral health quality of life (OHQoL), and the Behçet's disease current activity form (BDCAF). Patients were divided into three groups: one group used the BD MW, one group used a betamethasone mouthwash, and the other used no therapeutic mouthwash. Patients were assessed at three and six months. The OUSS in those using the BD MW was nine times lower than it was in those using betamethasone mouthwash (p=0.001), and 12 times lower than it was in the no mouthwash group (p=0.001). Compared with the baseline data, use of the BD MW during the first three months significantly reduced the OUSS, the BDCAF score, and intraoral scarring, and also improved OHQoL (p=0.001, 0.019, 0.012, and 0.001, respectively). Ongoing use of the BD MW after six months significantly improved the OUSS, OHQoL, and intraoral scars, and kept oral and systemic disease activity under control. A total of 20/31 patients reported high levels of satisfaction with its use, and a patients' satisfaction score showed a preference for it. This study confirms the efficacy of the BD MW in patients with recurrent oral ulceration (ROU). It is more efficacious than betamethasone mouthwash used alone.

Validation of New Wound Based Diabetic Ulcer Severity Score (DUSS)

Validation of New Wound Based Diabetic Ulcer Severity Score (DUSS)