Severe Ulceration Research Articles

Role of traditional healers in the management of microbial keratitis in eastern Nepal

Background Microbial Keratitis (MK) is a leading cause of corneal blindness due to infection and its consequences, with a higher incidence in resource-limited nations. Hospital-based patient records from different parts of Nepal suggest patients often use traditional eye medicine to treat MK. Traditional healers (TH) within the community are often the first point of care for MK management. Little is known of their practice, perceptions, and knowledge around MK management. We aimed to understand the role of traditional healers in the management of MK in south-eastern Nepal. Methods A cross-sectional, mixed method, descriptive study was conducted in the Siraha district of Nepal. A total of 109 traditional healers consented to participate in a survey of knowledge, attitude, and practices. Some participants were also invited to participate in in-depth interviews and focus group discussions. Interviews and focus groups were conducted and recorded in the Maithili language by a native speaking interviewer and transcribed into English. Descriptive analysis was performed for the survey. Data saturation was considered the endpoint for qualitative data collection, and a thematic was analysis applied. Results Traditional healers believe that infection of the eye can be caused by trauma, conjunctivitis, or evil spirits. They were unclear about differentiating MK from other eye conditions. They provided various types of treatment. Some were confident that they could treat severe ulcers that had not responded to medical therapy, while others thought treating larger diameter ulcers would be difficult. Although there were mixed responses in referring patients with MK, the majority of TH were willing to refer. Conclusion In a weak health system, traditional healers may help address barriers to healthcare access and reduce delays to definitive care, upon integration into the formal health system and referral pathway.

Antioxidant anthocyanin synergistic immune enhancer nanopeptide C-I20 remarkably enhances the protective effect of largemouth bass against largemouth bass ranavirus

Largemouth bass ranavirus (LMBV) infection results in huge economic losses in largemouth bass (Micropterus salmoides) industry. Nanopeptide C-I20 and anthocyanins have a positive effect on promoting immune responses and antioxidant mechanisms in several aquatic organisms, and are therefore used to inhibit LMBV infection. In this study, we developed an LMBV immersion challenge model using three different viral concentrations (1×104 copies/mL, 1×105 copies/mL, and 1×106 copies/mL) to infect largemouth bass, and LMBV-MCP mRNA expression was detected in infected fish. Following infection, the fish exhibited severe external ulceration, redness swelling, and darkening of the skin. Histopathological examination revealed significant necrosis and inflammation in muscle tissue, epithelial cell shedding in renal tubules, macrophage aggregation centers and cellular vacuolization in spleen and head kidney, and cellular hypertrophy in liver. To mitigate LMBV infection, we explored the protective effects of a combined treatment strategy involving C-I20 and anthocyanin. Overall, the combination of anthocyanin and C-I20 demonstrated the highest protective efficacy, significantly reducing viral loads in muscle, liver, spleen, and head kidney. Moreover, this treatment regimen enhanced antioxidant enzyme activities (T-AOC, TSOD, GSH-Px, CAT) and modulated important immune genes (IL-1, IL-8, TNF-α, IL-10, Mx, and IgM) expression. In conclusion, the synergistic application of anthocyanin and C-I20 demonstrates significant efficacy in mitigating LMBV infection. This research introduces a novel and promising approach to managing infectious diseases in aquaculture settings.

Sporotrichosis Presenting as a Severe Ulcer in an Elderly Diabetic Man.

Sporotrichosis Presenting as a Severe Ulcer in an Elderly Diabetic Man.

The relationship between dietary phytochemical index and novel anthropometric indices and the severity of diabetic foot ulcers in adults with type 2 diabetes: a cross-sectional study

BackgroundResearch on the relationship between dietary phytochemical intake and the anthropometric indices as well as the diabetic foot ulcers (DFUs) remains inconsistent. We aimed to investigate the associations of dietary phytochemical index (DPI) with the novel anthropometric indices and the severity of DFUs.MethodsThis cross-sectional study was conducted on 339 adults with type 2 diabetes. Dietary intake was assessed using three 24-hour dietary recalls. To quantify the phytochemical content of the diet, the DPI estimation was done through an equation proposed by McCarty. The International Working Group on the Diabetic Foot (IWGDF) criteria and Wagner classification system were applied to assess DFUs. New anthropometric indices including a body shape index (ABSI), body roundness index (BRI) and abdominal volume index (AVI) were calculated based on formulas. We employed analysis of variance (ANOVA), analysis of covariance (ANCOVA) and logistic regression to explore associations between DPI and the anthropometric indices and DFU variables.ResultsOur results revealed no significant association between DPI and the foot ulcer indices, following adjusting for the possible covariates. Furthermore, we also examined the relationship between diabetic neuropathy, as measured by monofilament score, and the DPI. Similarly, we did not find any substantial relationship between the DPI and monofilament score (OR: 1.18; 95% CI: 0.66–2.09; Ptrend = 0.56), as well as biochemical indices. Our analysis did not reveal any significant associations between the DPI and ABSI (OR: 0.70; 95% CI: 0.35–1.38; Ptrend = 0.30), BRI (OR: 0.80; 95% CI: 0.33–1.95; Ptrend = 0.59), and AVI (OR: 1.99; 95% CI: 0.92–4.33; Ptrend = 0.08).ConclusionsOur study revealed no significant links between the DPI and foot ulcer indices, neuropathy measures, and anthropometric indices. These findings imply that factors beyond dietary phytochemical intake may exert greater influence on the development of foot ulcers in diabetes.

Dogs receiving cyclooxygenase-2-sparing nonsteroidal anti-inflammatory drugs and/or nonphysiologic steroids are at risk of severe gastrointestinal ulceration.

To report the incidence and characteristics of gastrointestinal ulceration lesions in dogs receiving an NSAID and/or corticosteroid. 33 dogs. Medical records of dogs with gastrointestinal ulceration receiving NSAIDs and/or corticosteroids within 30 days of diagnosis between January 2012 and July 2022 at multiple referral institutions were reviewed. Diagnosis was confirmed via endoscopy, surgery, or necropsy. Clinical data were collected from the medical record, including the dose and reason for administration of NSAIDs or steroids. Dogs received a single NSAID (n = 22, most commonly carprofen [9], meloxicam [4], and deracoxib [3]), 2 NSAIDs (5), a single steroid (5: prednisolone [2], prednisone [2], or dexamethasone SP [1]), or an NSAID and steroid (1). Eleven dogs receiving a single cyclooxygenase (COX)-2-sparing NSAID at an appropriate dose had ulcerations. All dogs receiving 2 NSAIDs concurrently experienced full-thickness perforation (5 of 5). The most common ulcer locations were duodenum (n = 18) and pylorus (11). Abdominal ultrasound correctly identified the site of ulceration in 5 of 24 dogs. Dogs receiving COX-2 sparing NSAIDs at recommended doses are at risk of severe GI ulceration. Carprofen was the most common NSAID resulting in ulceration; however, it is one of the most prescribed NSAIDs. Adding another NSAID and steroid could increase this risk. Careful monitoring is crucial for dogs on NSAIDs, regardless of duration.

Facial edema and necrotic ulcers: a cutaneous reaction to liraglutide.

Due to rising obesity rates, new drugs like liraglutide, a GLP-1 receptor agonist, are increasingly used for weight loss. While liraglutide-related skin reactions are rare, this case report describes a 44-year-old male with severe facial edema and necrotic ulcers following liraglutide administration. Despite having taken the drug five years earlier without issue, the patient developed symptoms after receiving two doses. A skin biopsy revealed necrosis and inflammation, and the condition was successfully treated with steroids. The report underscores the need to consider cutaneous adverse effects in patients using liraglutide.

Fermented Soymilk with Probiotic Lactobacilli and Bifidobacterium Strains Ameliorates Dextran-Sulfate-Sodium-Induced Colitis in Rats.

Background: Current treatments for inflammatory bowel disease (IBD) are relatively futile and the extended use of drugs may reduce effectiveness. Several probiotic strains have shown promise in relieving/treating IBD symptoms. Objectives: The current study investigated the impact of fermented soymilk with a mixture of probiotic starter cultures containing Lactobacillus rhamnosus, L. casei, L. plantarum, L. acidophilus, Bifidobacterium longum, and B. animalis subsp. lactis in rats with dextran sulfate sodium (DSS)-induced colitis compared to control. Methods: Rats were randomly assigned to five groups (5 rats/group; n = 25): G1: negative normal control; G2: positive control (DSS); G3: DSS with sulfasalazine (DSS-Z); G4: DSS with soymilk (DSS-SM), and G5: DSS with fermented soymilk (DSS-FSM). Parameters monitored included the following: the disease activity index (DAI), macroscopic and histological assessments of colitis, and a fecal microbial analysis performed to assess the severity of inflammation and ulceration. Results: The DSS-FSM rats group exhibited lower DAI scores (p < 0.05) than other treated groups during the induction period. A macroscopical examination revealed no ulceration or swelling in the intestinal mucosa of rats in the DSS-FSM-treated group, resembling the findings in the negative control group. In the positive control (DSS group), the colon tissue showed increased inflammation (p < 0.05), whereas those in the DSS-SM- and DSS-FSM-treated rats groups did not show significant macroscopic scores of colitis. The positive DSS control and DSS-Z groups had crypt erosion and ulceration areas, severe crypt damage, and epithelial surface erosion, which were absent in the negative control and DSS-FSM groups. The counts of Lactobacillus spp. and Bifidobacterium spp. remained stable in both G1 and G5 over 4 weeks. The consumption of fermented soymilk with a mixture of probiotics could minimize the severity of DSS-induced colitis in rats. Conclusion, it was found that fermented soymilk containing Lactobacilli and Bifidobacterium might be an effective vehicle for reducing the severity of DSS-induced colitis in rats.

Salvataje de amputación mediante la aplicación de células madre autólogas de médula ósea en isquemia crítica de miembro inferior: reporte de caso

Critical ischemia of the lower limbs can seriously impair the quality of life of patients due to the intense pain associated with it and the amputation that can result in those who are not candidates for revascularization. Therefore, it is worthwhile to search for therapies that provide a recovery option for this group of patients. We describe the case of a 71-year-old male patient with critical ischemia in the right lower limb, associated with severe ulceration and infection, with an indication for amputation, who was saved from this procedure by the intramuscular administration of autologous bone marrow stem cells. The intramuscular administration of autologous bone marrow stem cells could promote angiogenesis and the survival of amputation.

Multimodal Identification of Molecular Factors Linked to Severe Diabetic Foot Ulcers Using Artificial Intelligence.

Diabetic foot ulcers (DFUs) are a severe complication of diabetes mellitus (DM), which often lead to hospitalization and non-traumatic amputations in the United States. Diabetes prevalence estimates in South Texas exceed the national estimate and the number of diagnosed cases is higher among Hispanic adults compared to their non-Hispanic white counterparts. San Antonio, a predominantly Hispanic city, reports significantly higher annual rates of diabetic amputations compared to Texas. The late identification of severe foot ulcers minimizes the likelihood of reducing amputation risk. The aim of this study was to identify molecular factors related to the severity of DFUs by leveraging a multimodal approach. We first utilized electronic health records (EHRs) from two large demographic groups, encompassing thousands of patients, to identify blood tests such as cholesterol, blood sugar, and specific protein tests that are significantly associated with severe DFUs. Next, we translated the protein components from these blood tests into their ribonucleic acid (RNA) counterparts and analyzed them using public bulk and single-cell RNA sequencing datasets. Using these data, we applied a machine learning pipeline to uncover cell-type-specific and molecular factors associated with varying degrees of DFU severity. Our results showed that several blood test results, such as the Albumin/Creatinine Ratio (ACR) and cholesterol and coagulation tissue factor levels, correlated with DFU severity across key demographic groups. These tests exhibited varying degrees of significance based on demographic differences. Using bulk RNA-Sequenced (RNA-Seq) data, we found that apolipoprotein E (APOE) protein, a component of lipoproteins that are responsible for cholesterol transport and metabolism, is linked to DFU severity. Furthermore, the single-cell RNA-Seq (scRNA-seq) analysis revealed a cluster of cells identified as keratinocytes that showed overexpression of APOE in severe DFU cases. Overall, this study demonstrates how integrating extensive EHRs data with single-cell transcriptomics can refine the search for molecular markers and identify cell-type-specific and molecular factors associated with DFU severity while considering key demographic differences.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part II/III): Biomaterials and keratoprosthesis.

The surgical reconstruction of severe corneal ulcers is a common and crucial component of the clinical practice of veterinary ophthalmology. Numerous surgical techniques are used in dogs for corneal reconstruction, and these techniques may be categorized by the material used to repair the corneal lesion. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues. In this second part of the review, the categories of biomaterials and keratoprosthetics will be summarized. Biomaterials that are reported for use in dogs include amniotic membrane, porcine urinary bladder acellular matrix, porcine small intestinal submucosa, acellular porcine corneal stroma, and other miscellaneous soft tissue and cartilage grafts (e.g., preserved equine renal capsule, autologous omentum, autologous buccal mucosa membrane, bovine pericardium, and homologous peritoneum). Descriptions of keratoprosthesis surgery in dogs are currently limited, but the use of artificial corneal transplants hold promise for dogs with severe, vision-compromising corneal disease that is not amenable to other reconstruction techniques. This review describes the results of experimental studies evaluating these graft materials in dogs, and it will summarize the findings and outcomes of the clinical articles published in each material category. Reporting inconsistencies and areas where additional research is required will be highlighted to help guide future studies in this area. A major aim of this review is to help identify potential subjects that could be evaluated in future investigations and that might lead to refinements in clinical practice.

Troxerutin effect on gastric ulcers induced by ketorolac in rats: Relation with oxidative stress

Gastric ulcers are an essential side effect associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). Free radicals are one of the important mechanisms contributing to the development of gastric ulcers caused by NSAIDs. This prompted us to choose troxerutin, which has antioxidant and anti-inflammatory effects, especially with a lack of studies investigating the preventive effect of troxerutin on gastric ulcers. Twenty-nine rats were divided into five groups: A Vehicle group, a Keto group (30 mg/kg of ketorolac), and two troxerutin groups (150 mg/kg or 200 mg/kg of troxerutin, respectively). A Miso group was used as a reference with (100 μg/kg of misoprostol). Troxerutin and misoprostol were administered orally 1 h before ketorolac. The ulcer index was determined considering the numbers and severity of ulcerations. Gastric tissue inflammation was evaluation microscopically. Both thiobarbituric acid reactive substance levels and catalase activity were measured as markers of oxidative stress in gastric tissue. Our data showed an improvement in ulcer indices with troxerutin and misoprostol compared with ketorolac, with improvement in gastric inflammation observed with misoprostol but not with troxerutin. These results were accompanied by a reduction in gastric oxidative stress induced by ketorolac with both troxerutin and misoprostol. This study highlights, for the first time, the antioxidant effect of troxerutin on gastric ulcers. This effect may contribute to the good prevention of ketorolac-induced gastric ulcers.

Phosphodiesterase4 inhibitors in dermatology : Role in the treatment of skin diseases

Chronic inflammatory skin diseases are of great social and medical importance and require effective drug therapy. Phosphodiesterase4 (PDE4) inhibitors represent apossible therapeutic option by regulating inflammatory processes. PDEs cause the release of proinflammatory cytokines by interfering with signaling pathways. The PDE4 inhibitors apremilast (treatment of psoriasis and Behçet's disease), roflumilast (treatment of chronic obstructive pulmonary disease), and crisaborole (treatment of atopic dermatitis) are currently approved in Europe. Apremilast is used for second-line treatment of plaque psoriasis and psoriatic arthritis and has afavorable side effect profile. Topical PDE4 inhibitors are currently being researched and have not yet been approved by the European Medicines Agency (EMA). The topical PDE4 inhibitor crisaborole was approved by the EMA in 2020 as atopical treatment alternative to glucocorticoids and calcineurin inhibitors. Although the substance has shown good tolerability in studies and also alleviates the accompanying itching, it did not find its way onto the German market. BEHçET'S DISEASE: Apremilast is approved for the treatment of Behçet's disease in adults with refractory, severe oral ulcers. Case studies have also demonstrated the efficacy of systemic PDE4 inhibition in other skin diseases (including blistering autoimmune dermatoses, lichen planus, and acantholytic genodermatoses). The substances are also being researched and used to treat extracutaneous inflammatory diseases.

MR enterography radiologic ulcers in newly diagnosed ileal Crohn disease in children: frequency, inter-radiologist agreement, and clinical correlation

BackgroundRadiologic ulcers are increasingly recognized as an imaging finding of bowel wall active inflammation in Crohn disease (CD).ObjectiveTo determine the frequency of ulcers at MR enterography (MRE) in children with newly diagnosed ileal CD, assess agreement between radiologists, and evaluate if their presence correlates with other imaging and clinical features of intestinal active inflammation.Materials and methodsThis retrospective study included 108 consecutive pediatric patients (ages 6–18 years) with newly diagnosed ileal CD that underwent clinical MRE prior to treatment initiation between January 2021 and December 2022. MRE examinations were independently reviewed by three pediatric radiologists who indicated the presence vs. absence of ulcers, ulcer severity (categorical depth), and ulcer extent (categorical number of ulcers). Maximum bowel wall thickness and length of disease were measured and averaged across readers. Patient demographics and clinical inflammatory markers were documented from electronic health records. Inter-radiologist agreement was assessed using Fleiss’ kappa (k) statistics. Student’s t-test was used to compare continuous variables.ResultsMean patient age was 13.9 years (67 [62%] boys). Radiologic ulcers were recorded in 64/108 (59.3%) cases by reader 1, 70/108 (64.8%) cases by reader 2, and 49/108 (45.4%) cases by reader 3 (k = 0.36). Based on majority consensus, radiologic ulcers were present in 60/108 (55.6%) participants. Inter-radiologist agreement for ulcer severity was k = 0.23, while ulcer extent was k = 0.66. There were significant differences in C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, albumin, maximum bowel wall thickness, and length of disease between patients without and with radiologic ulcers (P < 0.05). The sensitivity and specificity of MRE for detecting endoscopic ulcers were 66.7% (95% CI, 52.1–79.2%) and 69.2% (95% CI, 48.2–85.7%), respectively.ConclusionRadiologic ulcers are visible in children with newly diagnosed ileal CD, although inter-radiologist agreement is only fair. The presence of ulcers is associated with clinical laboratory inflammatory markers as well as other MRE findings of disease activity and is an additional imaging finding that can be used to evaluate intestinal inflammation.

Effect of autologous serum after amniotic membrane transplantation for persistent corneal ulcers.

To investigate the effect of adding autologous serum eye drops to the postoperative regime after amniotic membrane transplantation for severe persistent corneal ulcers. Forty eyes of 40 patients with persistent corneal ulcers were randomly assigned to artificial tears (sodium hyaluronate 0.2%, ATs group, n=20) or autologous serum eye drops (ASEDs, n=20) following treatment with amniotic membrane transplantation. Digital slit lamp images were acquired from all patients before and 30d post treatment. The area with fibrovascular tissue was calculated using Image J. Central corneal sensitivity was assessed by Cochet-Bonnet aesthesiometry before and one month after treatment. Scar tissue transparency was assessed with a novel optical densitometry. Mean age of patients was 61.65±16.47y and 57.3±19.11y in the ATs group and ASEDs group, respectively. Twenty-two male and 18 female patients were included in the study. The improvement in visual acuity was significantly greater in the ASEDs group (0.14±0.04) than the ATs (0.08±0.04; P=0.00046). Cochet-Bonnet aesthesiometry improved significantly after treatment with a similar rate between groups. There were no statistically significant differences in the area of postoperative fibrovascular tissue between the two groups (P=0.082). The success rate in the two groups was similar. The difference in densitometry between the ATs and ASEDs group was statistically significant (P=0.042) with greater reduction from baseline in the ASEDS group. Autologous serum eye drops can lead to better visual acuity, more stable results and improved densitometry and should be considered in the postoperative care following amniotic membrane transplantation.

Effects of aqueous seed extract of &lt;i&gt;Garcinia kola&lt;/i&gt; on spray paint-induced histological changes in the lungs of Wistar rats

The most common cause of lung diseases among people with spray paint-related occupations is hydrocarbon poisoning which has significant morbidity and mortality if left untreated. This study aimed to investigate the effects of aqueous seed extract of Garcinia kola on spray paint-induced interstitial pneumonitis in the adult Wistar rats. Thirty adult Wistar rats weighing between 240 g and 270 g were divided into five groups of six rats each. Animals in group A were placed on feed and water only. Animals in group B were exposed to 100 ml of spray paintfumes via inhalation. Animals in group C received 500mg/kg body weight per day of Garcinia kola. Animals in group D were exposed to 100 ml of spray paint fumes via inhalation and received 250mg/kg body weight per day of Garcinia kola. Animals in group E were exposed to 100 ml of spray paint fumes via inhalation and received 500mg/kg body weight per day of Garcinia kola. The extract was administered for 30 consecutive days via an orogastric tube. Groups A, C, D and E revealed normal histoarchitecture of the lung; normal alveoli and normal interstitial space. There were observable histological variations in the lung tissues of Group B rats which include severe alveolar dilation, interstitial haemorrhage, interstitial infiltrates of inflammatory cells, severe vascular ulceration and congestion (evidence of interstitial pneumonitis). It is concluded that Garcinia kolahasan ameliorative effect on spray paint-induced histological changes in the lungs of Wistar rats.

Application of the Health Belief Model (HBM) in Buruli Ulcer Education: A Literature Review

Introduction: The basic principles of the Health Belief Model as a theoretical foundation were employed to examine Buruli ulcer education. The study employed various strategies to obtain relevant studies about the constructs of the Health Belief Model which were relevant in the context of Buruli ulcer education. Method: The strategies used sought to uncover studies that have applied the Health Belief Model as a theoretical framework or theoretical foundation in Buruli ulcer education especially within Ghana and found none. Review of studies was carried out through electronic databases searches, grey materials and electronic books. Search strategy with key terms related to Health Belief Model and Buruli ulcer were employed to retrieve relevant documents. The study considered only references that were relevant to the constructs of the theory and could be used to explain Buruli ulcer education. Results: The study considered the six constructs of the theory and these included (people perceived susceptibility to Buruli ulcer, perceived severity of Buruli ulcer, perceived benefit of not contracting Buruli ulcer, perceived barriers to Buruli ulcer healthcare, cues to action for Buruli ulcer and Buruli ulcer knowledge self-efficacy), and modifying factors. The theory has been used in health education for health related events and hence was considered the appropriate theory in the context of Buruli ulcer education. Conclusion: The fundamental idea of the theory is based on the individual personal belief about the disease and the methods that exist to be used to help in the reduction of risk factors. Hence public health workers could employ the theory to help in reduction of risk factors exposures among the population especially in endemic communities in Africa.

Use of Silver Dressing on Diabetic Ulcers During Infection: Case Report

Aims: This study aimed to describe the results of applying silver dressing on diabetic ulcers during infection in patients with infected wounds on digiti one pedis dextra. Methods: This research uses a descriptive design, namely a case study with a nursing approach consisting of assessment, analysis of problem formulation, formulation of nursing diagnosis, intervention, implementation, evaluation, and nursing documentation. The subject of this case study is Mrs. A with diabetic ulcers on Digi 1 pedis extra with infection. Case management was carried out for three days on April 17-19, 2024. Data was collected through anamnesis, wound assessment, supporting examination, and literature study. Wound assessment was performed using the Meggitt-Wagner instrument for assessing wound severity and the SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, Area ulcer, and Depth) system for improving foot ulcer management according to their severity and predicting major adverse foot events. Results: After three days of treatment using silver dressing, the wound condition shows that the infection has been resolved, and the wound has improved significantly from a grade 2 diabetic ulcer with abscess using the Meggitt-Wagner instrument and a SINBAD score of 3 (less severe ulcer) to a grade 2 diabetic ulcer without abscess and a SINBAD score of 2 (less severe ulcer). Conclusion: Wound care using silver dressing significantly accelerates the resolution of infections and supports the overall healing process

Spinal Cord Stimulation for Intractable Chronic Limb Ischemia: A Narrative Review.

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is not possible or fails, spinal cord stimulation (SCS) may be a treatment option. Currently, SCS is primarily prescribed as a symptomatic treatment for painful symptoms. It is used to treat intractable pain arising from various disorders, such as neuropathic pain secondary to persistent spinal pain syndrome (PSPS) and painful diabetic neuropathy. Data regarding the effect of SCS in treating CLI are varied, with the mechanism of action of vasodilatation in the peripheral microcirculatory system not yet fully understood. This review focuses on the surgical technique, new modalities of SCS, the mechanisms of action of SCS in vascular diseases and the parameters for selecting CLI patients, along with the clinical outcomes and complications. SCS is a safe and effective surgical option in selected patients with CLI, where surgical or endovascular revascularization is not feasible.

Diagnosis of Pressure Ulcer Stage Using On-Device AI

Pressure ulcers are serious healthcare concerns, especially for the elderly with reduced mobility. Severe pressure ulcers are accompanied by pain, degrading patients’ quality of life. Thus, speedy and accurate detection and classification of pressure ulcers are vital for timely treatment. The conventional visual examination method requires professional expertise for diagnosing pressure ulcer severity but it is difficult for the lay carer in domiciliary settings. In this study, we present a mobile healthcare platform incorporated with a light-weight deep learning model to exactly detect pressure ulcer regions and classify pressure ulcers into six severities such as stage 1–4, deep tissue pressure injury, and unstageable. YOLOv8 models were trained and tested using 2800 annotated pressure ulcer images. Among the five tested YOLOv8 models, the YOLOv8m model exhibited promising detection performance with overall classification accuracy of 84.6% and a mAP@50 value of 90.8%. The mobile application (app) was also developed applying the trained YOLOv8m model. The mobile app returned the diagnostic result within a short time (≒3 s). Accordingly, the proposed on-device AI app can contribute to early diagnosis and systematic management of pressure ulcers.

Clinical profiling, treatment characteristics and outcome in Behcet's Disease (BD)-A retrospective cohort study from Karnataka Rheumatology Association (KRA).

Behcet's disease (BD) has a heterogeneous and unpredictable phenotype that differs in various geographical areas. To describe the clinical phenotype & outcome of Behcet's disease(BD) from Karnataka, India and compare them with large cohorts from endemic regions. Databases of practising rheumatologists from Karnataka were reviewed to retrieve clinical characteristics, course of illness, prescribing information and outcome at last follow-up of patients clinically diagnosed as BD. The classification criteria, namely revised International criteria for Behcet's disease (rICBD) and International study group (ISG) criteria were applied. Outcome was defined as complete or partial remission, persistent disease or relapse. We included 72 patients, equal gender distribution and mean age 37.4 ± 12.8years from 8 rheumatology centres. Commonest presentations were recurrent oral aphthosis 58(80.6%), genital ulcers 36(50%) and ocular manifestations 40(55.6%). Three-quarters [51/72(70.8%)] fulfilled rICBD criteria whereas only half [36/72(50%)] fulfilled ISG criteria. Apart from glucocorticoids [53/72(73.6%)], frequently prescribed therapies were colchicine 39(54.2%) and azathioprine 35(48.6%). Eleven-patients received biologics(anti-TNF-α) and JAK inhibitors to treat severe organ involvement. HLA-B*51 and pathergy tests were positive in 27/45(60%) and 12/34(35.3%) patients respectively. Outcomes were documented in 94.4%(68/72) patients at median follow-up of 24 (12;36) months. Majority [46/68(67.6%)] had complete remission, 17/68(25%) had partial remission, 4/68(5.9%) had persistent while 1/68(1.5%) had relapsing course. Majority of BD patients had orogenital aphthosis and ocular manifestations and an excellent response to treatment. Key Points • In our region, Behçet's Disease primarily manifests with recurrent oral aphthae and ocular involvement, with comparatively lower incidence of severe genital ulcers and neurological involvement than in endemic regions. • Apart from glucocorticoids, colchicine and azathioprine are the most commonly used agents. Biologics and JAK inhibitors are prescribed infrequently, primarily in cases of severe organ involvement. • A significant proportion of patients achieved either complete or partial remission during follow-up, with no observed mortality suggesting a milder disease course and better outcome compared to endemic regions. • Gender, HLA-B*51 status, and pathergy response did not exert any significant influence on the clinical profile or outcome in BD patients in Karnataka.