Ulcer Size Research Articles

Axial ablation versus terminal interruption of the reflux source (AAVTIRS): a randomised controlled trial

BackgroundTreatment of superficial venous reflux has been shown to improve ulcer healing time and reduce the risk of ulcer recurrence. Terminal ablation of the reflux source (TIRS) is an alternative to formal endovenous ablation or surgery which can be performed by injecting sclerosant foam into the peri-ulcer plexus of the veins. TIRS has been shown to be successful and in our experience is the option preferred by many patients, when offered as an alternative to axial ablation (AA).AimTo determine if the proportion of ulcers healed within 6 months of endovenous treatment differs between patients undergoing AA of varicose veins or TIRS by peri-ulcer foam sclerotherapy.MethodsAAVTIRS is an assessor-blinded randomised controlled trial. Patients will be recruited from a dedicated ulcer clinic in Roscommon University Hospital and from the vascular surgical clinics in University Hospital Galway. All patients attending the ulcer clinic will be screened for eligibility.RandomisationRandom computer-generated sequence is stratified by ulcer size. Allocation will be concealed using sealed opaque envelopes.BlindingAssessors reviewing wounds at follow -p visits will be blinded to patient allocation.Primary endpointThe proportion of ulcers healed within 6 months of enrolment.DiscussionThis will be the first time that TIRS has been evaluated with a properly powered randomised trial in the setting of venous ulcer management. Streamlining the management of venous ulcers has broad health economic benefits. If it is found that TIRS is superior or non-inferior to AA, then a less expensive, less invasive injection can be offered as an alternative to AA in an attempt to encourage the healing of venous ulcers. If AA is found to be superior to TIRS, then this would suggest that all patients undergoing ablation in the management of venous ulcers should have their superficial reflux fully treated, building on the evidence of the EVRA trial.Trial registrationClinicalTrials.gov NCT04484168. Registered on 23 July 2020

Use of topical haemoglobin spray in hard-to-heal wound management: a systematic review.

To synthesise the best available evidence regarding the effectiveness of using topical haemoglobin spray to promote healing in hard-to-heal wounds in adults. The search strategy of this systematic review was designed to retrieve studies published across CINAHL, Medline, Cochrane Central Register of Controlled Trials, Web of Science, Embase, ERIC, Scopus and Mednar, before January 2020, and published in English. All study participants were aged ≥18 years. This review included randomised controlled trials, case-control studies and observational studies. The studies selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion using standardised critical appraisal instruments. The review included 15 studies. Overall effectiveness was demonstrated for wound closure rates, reductions in wound size, severity of wound pain and patient satisfaction with using a topical haemoglobin spray. The meta-analysis revealed a statistically significant effect of a topical haemoglobin spray in reducing the size of venous leg ulcers (VLU, effect size=0.02; 95% confidence interval: 0.00-0.09; p<0.00001) in adult patients. However, evidence of the effectiveness of using a topical haemoglobin spray in different wound types among adult patients was limited and not high-level, which precludes any strong conclusions. The review provides an evidence-based guide to future priorities for clinical practice. In particular, a topical haemoglobin spray was shown to have a positive impact in reducing VLU size and promoting wound healing.

Comparative Evaluation of Low-Level Laser Therapy and Topical Triamcinolone Acetonide 0.1% in Recurrent Aphthous Stomatitis Subjects.

BackgroundRecurrent aphthous stomatitis (RAS), sometimes known as canker sores, is an infection of the oral mucous membranes caused by an inflammatory process. Triamcinolone and low-level laser therapy for recurrent aphthous ulcers were studied in this research, which evaluated their clinical efficacy.MethodologyAmong 60 subjects, 54 subjects fulfilled the inclusion criteria with an age range between 16 and 46 years. Subjects were randomly divided into two groups, the control group who received four times daily topical application of triamcinolone acetonide 0.1% and the test group who underwent a single application of low-level laser therapy on three alternate days. Evaluations were done on day 1, day 3, day 5, and day 10. Data obtained on oral-health-related quality of life (OHR-QoL) using the OHR-QoL questionnaire were used as baseline data. Clinical parameters like pain score were assessed using a visual analog scale, ulcer size using UNC-15 probe, and erythema and healing score were evaluated using erythema and healing scale.ResultAccording to the OHR-QoL data, there was no statistically significant difference in the quality of life of test and control subjects. We found that pain and ulcer size reduced considerably (p=0.007) from the first day to the third day (p=0.000), and then dropped significantly again (p=0.000) on days 3-10 (p=0.000). On days 3 and 5, the test group showed significant reductions in pain and erythema (p=0.13), as well as an improvement in ulcer healing when compared to the control group. On days 3 and 5, the size of the ulcers decreased similarly in the control and test groups. On the 10th day, patients in both groups had less discomfort, erythema, and ulcer size, as well as improved healing of the ulcer.ConclusionPain and erythema reduction and ulcer healing improvement were significantly higher in subjects in the test group as compared to those in the control group by day 3. The reduction in ulcer size was comparable to the control group on days 3 and 5, while the complete reduction in ulcer size was seen in both groups by day 10.

Oral Ulcer Healing Activity of Lemon Pepper Ethanol Extract Gel in Streptozotocin-Induced Diabetic Wistar Rats

Diabetes mellitus (DM) is a metabolic condition where the body's ability to produce and utilize insulin is impaired; thus, wound healing process is slower than usual in patients with DM. Lemon pepper has both antioxidant and anti-inflammatory properties. This study aimed to investigate the effect of topical application of lemon pepper fruit ethanol extracts on the healing process of oral traumatic ulcers in diabetic rats. This study was performed at the Pharmacology Laboratory, Faculty of Medicine, Universitas Prima Indonesia from September 2021–October 2021. Thirty males diabetic Wistar rats were thermally injured on the lower labial mucosa and divided into five groups: control, standard, and lemon pepper gel 5%, 7.5%, and 10% groups. The ulcer size was measured after injury and on the 7th and 14th day. On the last day, all rats underwent both routine blood count and histology study for oral ulcer tissue. On the 14th day, all treatment groups showed some significant difference wound contraction, with the highest tendency of wound contraction seen in both lemon pepper gel 10% and standard groups (62.50%. p-value =0.001). The improvement of wound contraction was also supported by reduced white blood cell count (p-value&lt;0.05) in routine blood count and regeneration of epidermis and dermis tissues in the histology study. Hence, it can be concluded that the lemon pepper extract gel in all concentrations has good physical stability and the lemon pepper gel with the highest concentration group presents the best ulcer healing activity compared to other concentrations and has similar ulcer healing activity as the standard group that receives Kenalog® in Orabase.

A comparative study of efficacy of silver stream versus povidone iodine in healing the diabetic ulcers

Background: Diabetic ulcers affect morbidity, mortality and QOL of patients. Wound debridement and dressing using antiseptics are part of standard treatment. Silver stream solution containing silver ions, menthol, glycerol and surfactant has shown promising results in chronic DFU. But no clinical trials have been conducted yet. The aim of the study was to compare effectiveness of silver stream solution with traditionally used povidone iodine in healing diabetic ulcers.Methods: 100 diabetic ulcer patients randomly divided into 2 groups A and B of 50 each, received ulcer dressing with silver stream solution or povidone iodine respectively every 48 hourly. Ulcer size and healing was evaluated at 2 weeks intervals for 8 weeks or till ulcer healed.Results: Patients of both groups were comparable in their age/sex distribution, duration, control of diabetes and pre-treatment mean ulcer size. At end of 8 weeks, percentage reduction in mean ulcer size was much more in group A (89.51%) than in group B (33%). All patients treated with silver stream responded, though response was partial in (10%). Patients having poor glycemic control. In contrast only 46% showed complete response to povidone iodine, 42% had partial response and 12% did not responded.Conclusions: Response rate with silver stream dressing is significantly higher and reduction in mean ulcer size at end of 8 weeks treatment is significantly more than with povidone iodine.

Protective Effects of Cannabidiol on Chemotherapy-Induced Oral Mucositis via the Nrf2/Keap1/ARE Signaling Pathways.

Oral mucositis (OM) is a common complication during chemotherapy characterized by ulceration, mucosa atrophy, and necrosis, which seriously interferes with nutritional intake and oncotherapy procedures among patients. However, the efficacy of current treatments for OM remains limited. Cannabidiol (CBD) is a natural cannabinoid with multiple biological activities, including antioxidant and anti-inflammatory potential. In this study, we aimed to investigate the chemopreventive effects and mechanisms of CBD in protecting C57BL/6N mice and human oral keratinocytes (HOK) from 5-fluorouracil- (5-FU-) induced OM. Here, we found that CBD alleviated the severity of 5-FU-induced OM in mice, including improved survival, decreased body weight loss, reduced ulcer sizes, and improved clinical scores. Histologically, CBD restored epithelial thickness and normal structure in tongue tissues. Meanwhile, CBD attenuated reactive oxygen species (ROS) overproduction and improved the antioxidant response, suppressed the inflammatory response, promoted the proliferation of epithelial cells, and inhibited 5-FU-induced apoptosis. In vitro, consistent outcomes showed that CBD suppressed cellular ROS levels, enhanced antioxidant ability, reduced inflammatory response, promoted proliferation, and inhibited apoptosis in 5-FU-treated HOK cells. In particular, CBD upregulated the expression levels of antioxidant enzymes, heme oxygenase-1 (HO-1) and NAD(P)H quinine oxidoreductase 1 (NQO1), by increasing the expression and nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) and decreasing Kelch-like ECH-associated protein 1 (Keap1). Notably, the Nrf2 inhibitor ML385 reversed the protective effect of CBD. Nrf2-siRNA transfection also significantly blunted the antioxidant effect of CBD in in vitro OM model. Collectively, our findings suggested that CBD protected against 5-FU-induced OM injury at least partially via the Nrf2/Keap1/ARE signaling pathways, highlighting the therapeutic prospects of CBD as a novel strategy for chemotherapy-induced OM.

Incidence and risk factors for rebleeding after emergency endoscopic hemostasis for marginal ulcer bleeding

BackgroundMarginal ulcer bleeding is a cause of upper gastrointestinal bleeding, but the efficacy of emergency endoscopic hemostasis and risk factors for rebleeding have not been fully explored. The purpose of the current study was to investigate the rebleeding rate and risk factors after emergency endoscopic hemostasis for marginal ulcer bleeding. MethodsWe conducted a retrospective study of 105 patients who underwent emergency endoscopic hemostasis due to marginal ulcer bleeding from January 2015 to July 2021. Patients included in this study were divided into rebleeding and non-rebleeding groups. ResultsAmong the 105 patients, 15.2% (16/105) patients developed rebleeding within 30 days after endoscopic hemostasis, and 87.5% of the patients had rebleeding within 7 days. The mean age of these patients was 60.3 ± 12.3 years, and 95 of them were male. In the univariate analysis, an ulcer size ≥10 mm, a PLT count <100 × 10^9/L and an AIMS65 score ≥2 were risk factors for rebleeding. According to the multivariable analysis, an ulcer size ≥10 mm (OR: 3.715; 95% CIs: 1.060–14.250; p = 0.043) and a PLT count <100 × 10^9/L (OR: 4.480; 95% CIs: 1.099–18.908; p = 0.035) were independent risk factors for rebleeding. ConclusionEmergency endoscopic hemostasis is an effective treatment for marginal ulcer bleeding. An ulcer size ≥10 mm and a PLT count <100 × 10^9/L were independent risk factors for rebleeding within 30 days after endoscopic hemostasis for marginal ulcer bleeding.

Resistant Chronic Venous Leg Ulcers: Effect of Adjuvant Systemic Hyperbaric Oxygen Therapy Versus Venous Intervention Alone.

The aim of this study was to assess the adjuvant efficacy of adding systemic hyperbaric oxygen therapy (HBOT) to definitive venous intervention for healing of resistant chronic venous leg ulcers (VLUs). From 97 chronic VLUs, 63 were subjected to a pre-study standard wound care. Thirty three ulcers failed to achieve 50% size reduction, after the 4-weeks standard care, and were allocated to be treated with: HBOT plus venous intervention (n = 17), or venous intervention alone (n = 16). Primary outcomes were the change in ulcer area, complete healing frequency and time, as well as ulcer recurrence. There was a history of recurrent ulcer (82.3% vs. 69%) in HBOT versus venous intervention groups, respectively. The comparison between both groups with regard to area change showed non-significant difference after 3 months of therapy, while there was a significant difference at 6 and 12 months. A significant positive correlation was found between the HBO sessions numbers (20-40) and the rate of ulcer size reduction. Ulcer complete closure after 3 months was observed in (41.7%) of HBOT group, versus (23%) in venous intervention group; (p = 0.33). After 12 months, complete closure was observed in (83.3%) of HBOT group, versus (53.8%) in venous intervention group; (p = 0.02). The mean time of complete closure was significantly shorter in HBOT group, (p = 0.001). HBOT may be effective as adjuvant to venous intervention in treatment of chronic resistant VLUs, it should be reserved for persistent ulcer. Randomized controlled trials with larger numbers is still needed to elucidate its exact role and specific indications.

Enterobacter cloacae Keratitis: Clinicomicrobiological Profiles, Risk Factors, and Outcomes.

The purpose of the study was to report the clinical features, risk factors, antibiotic susceptibility, and treatment outcomes in a series of Enterobacter cloacae keratitis. A retrospective analysis was performed of the electronic medical records of microbial keratitis caused by E. cloacae identified by the Vitek 2 system (BioMerieux, Craponne, France). We collected data pertaining to demographics, risk factors, ulcer characteristics, antibiogram, visual acuity at presentation and final follow-up, and management outcome. The main outcome measure was resolution of infection. The final visual acuity was the secondary outcome measure. Ten episodes of E. cloacae keratitis in 9 patients were identified between January 2009 and December 2019. Nine (90%) cases had undergone penetrating keratoplasty and 8 were failed grafts. Other risk factors included topical steroid use and irregular ocular surface due to epithelial bullae. The mean ulcer size was 17.55 ± 13.99 mm 2 . More than 80% of isolates were sensitive to chloramphenicol, gentamicin, and colistin. Nine (90%) cases healed on medical management within 56.55 ± 26.74 days (range 9-120 d), although almost all required adjunctive procedures: tissue adhesive application (n = 6) and/or tarsorrhaphy (n = 4). One case with a near total infiltrate had a mixed infection with Kocuria kristinae requiring therapeutic penetrating keratoplasty. One case developed endophthalmitis and phthisis after the corneal infiltrate resolved. E. cloacae keratitis is a rare clinical entity seen more often in immunocompromised host conditions such as failed corneal transplants with concomitant topical steroids. Most cases healed with medical management.

Comparison of the Outcomes of Cadexomer Iodine and Povidone-Iodine Ointments in Wound Management.

BackgroundIn this era of upcoming newer formulations of topical ointments in the market, selecting an appropriate topical ointment for managing ulcers is challenging with regards to granulation tissue promotion, ulcer size reduction, and decrease in the amount of discharge from the ulcer. This study compares the outcomes of two topical iodine formulations, namely, cadexomer iodine ointment (0.9%) and povidone-iodine ointment (5%), for the management of various types of ulcers.MethodologyThis prospective, interventional study was conducted in a tertiary care hospital. After screening, 40 patients with ulcers (venous, arterial, diabetic, traumatic, infective) were subjected to simple randomization based on computer-generated random numbers at a ratio of 1:1 for the application of cadexomer (n = 20) (Group A) and povidone-iodine ointment (n = 20) (Group B). Selected patients were subjected to broad-spectrum antibiotics on admission and then shifted to special antibiotics based on the culture and sensitivity report of the wound. The application of these two formulations was done in three settings, each lasting 48 hours. The efficacy of these two formulations was assessed based on the following three parameters: (a) the percentage of granulation tissue promotion, (b) wound size reduction, and (c) decline in wound discharge. The study groups were compared using an unpaired t-test, while the association among the study groups was performed using Fishers’ test, Student’s t-test, and chi-square test. P-values less than 0.05 were considered significant.ResultsSignificant improvement (p < 0.05) in granulation tissue was observed with cadexomer ointment application compared to povidone-iodine ointment. Statistically significant reductions in ulcer size and discharge from ulcers were seen in both groups; however, clinically, cadexomer ointment was found to be more effective compared to povidone-iodine ointment in reducing ulcer size as well as in reducing the amount of discharge from ulcers.ConclusionsCadexomer iodine ointment proved to be better than povidone-iodine ointment in the management of ulcers regarding the percentage of granulation tissue promotion, ulcer size reduction, and decrease in the amount of discharge from ulcers.

Clinical Investigation of the Safety and Efficacy of Low-temperature Plasma as an Adjuvant Treatment for Mild to Moderate Fungal Keratitis: A Pilot Study

ABSTRACT Purpose This pilot study assessed the safety and efficacy of low-temperature plasma (LTP) as an adjuvant treatment for mild to moderate fungal keratitis (FK). Methods Thirty FK patients were randomized into LTP (n = 15) and control (n = 15) groups. Patients were followed up for 3 months. The best-corrected visual acuity (BCVA), ulcer size, and hypopyon height were measured; healing time or complications were documented and compared. Results More patients in the LTP group healed completely (11/15 in 48 days) compared with the control group (4/15 in 59.5 days), and those patients had a deeper initial ulcer depth and exhibited better BCVA improvements. Four patients failed after LTP treatment due to perforation, increased inflammatory infiltration, or hypopyon; those with more hypopyon were more likely to fail. Conclusions LTP could be a promising adjuvant therapy to topical antifungal drugs for mild to moderate FK.

The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers.

In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum-assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.

Is Corneal Collagen Cross-Linking Beneficial as an Adjunct to the Conventional Treatment of Bacterial Keratitis?

Background: To evaluate the therapeutic effects of corneal collagen cross-linking CXL as an adjuvant to standard antimicrobial agents in the treatment of bacterial keratitis when compared to treatment with antimicrobial agents alone. Methods: This prospective comparative interventional study included 20 eyes of 20 patients with clinical and laboratory evidence of bacterial keratitis who attended the Outpatient Cornea Unit, Ophthalmology Department, Faculty of Medicine in Assiut University Hospital, Assiut, between January 2019 and December 2020.Patients were divided into two groups: group A, treated with CXL using the Dresden Protocol at the EL-Nour Eye Centre, and group B treated with antibiotics alone. Results: Group A had ten patients in the age range of 20-80 years (mean age 49.2 years), while that of group B (ten patients) was 19 -70 years (mean age 47.3 years). The ulcer sizes started to decrease significantly from week 2 in group A to week 3 in group B. The epithelization time was significantly different between the two treatment groups as reepithelization in 60% of group A cases started at week two, while it began at week three in group B. There was no significant difference in the V/A between the two groups after treatment. Conclusion: CXL as an adjunct to topical antimicrobial treatment was more effective in treating bacterial keratitis than conventional antimicrobial therapy alone, as it led to shorter recovery times due to more rapid ulcer healing, resolution of infiltration, and faster symptomatic relief in patients. Despite CXL promoted the ulcer to heal quickly, there was no significant change in V/A before and after CXL or between the CXL with antimicrobial or antimicrobial therapy alone .

Scrophularia striata: Therapeutic and Healing Properties with an Emphasis on Oxidative Stress and Gastric Ulcer Treatment

: Some plants, including Scrophularia striata, have traditionally been used among people of the Zagros region for infection and wound healing. Therefore, the purpose of this research was to investigate the therapeutic and healing effects of S. striata with an emphasis on oxidative stress and gastric ulcer treatment. Antirrhinum majus, with a local name of S. striata, is a wildling and perennial plant from the A. majus family, found in most temperate and tropical regions of Iran, including Ilam. Substances, including cinnamic acid, quercetin, isorhamnetin-3-O-rutinoside, nepitrine, phenylpropanoid glycoside (osteoside 1), alcohol allyl, and D-N-octyl phthalate, have been identified in S. striata. People living in Ilam province have been using this plant experimentally for many years in various forms such as edible decoction, incense, and poultice in the treatment of various diseases such as inflammation and infection of the eyes and ears, skin burns, infectious wounds, episiotomy, pain, gastrointestinal disorders, colds, hemorrhoids, and boils. The S. striata extract has a significant positive effect on the size and number of gastric ulcers, and with increasing the concentration of the extract, the size and number of the wounds decrease. In general, the present study showed that the S. striata medicinal plant has a significant restorative effect on skin and gastrointestinal wounds, especially gastric ulcers, but clinical trials are required for the oral and therapeutic use of S. striata.

EFFICACY AND SAFETY OF A NOVEL MUCOADHESIVE CLOBETASOL PATCH FOR TREATMENT OF ORAL LICHEN PLANUS

<h3>Objectives</h3> Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa with no approved treatment. This was the first and largest global randomized, double-blind, placebo-controlled efficacy and safety OLP trial of a novel mucoadhesive clobetasol propionate patch (Rivelin-CLO). <h3>Study Design</h3> One hundred and thirty-eight adults with symptomatic OLP and ≥1 measurable ulcer were randomized to 1, 5, 20 µg/patch doses or placebo in 1:1:1:1 ratio. Up to 6 patches were applied BID for 4 weeks. The primary endpoint was total ulcer area reduction. Secondary endpoints included patient- and clinician-reported outcome measures. <h3>Results</h3> One hundred and twenty-two patients completed the study. All 138 patients were included in the efficacy and safety analyses. The 20-μg/patch treatment resulted in significant reduction in total ulcer area (−45.0 mm²; <i>P</i> < .05), symptom severity score (−2.967; <i>P</i> < .001; 28-point scale), clinician's severity assessment (−4.453; <i>P</i> < .05; 106-point scale), and oral mucosal disease-specific quality of life (−9.022; <i>P</i> < .05; 104-point scale). One- and 5 ug/patch treatments showed a positive impact but did not broadly reach significance. Patches were universally reported as easy to apply and remove, well tolerated, and associated with high compliance. Most adverse events deemed to be related to treatment were mild and localized and did not result in study discontinuation. <h3>Conclusions</h3> Rivelin-CLO 20 μg/patch treatment for 4 weeks resulted in clinically significant improvement in OLP ulcer size, symptoms, and quality of life, with a favorable safety profile, demonstrating its potential to address a significant unmet need in OLP. (Funded by Afyx Therapeutics A/S; EudraCT 2017-002193-40; ClinicalTrials.gov NCT03592342.)

The Efficacy and Safety of Pentoxifylline in the Treatment of Recurrent Aphthous Stomatitis: A Systematic Review

Several evidence have shown the beneficial effects of pentoxifylline in the improvement of oral aphthous ulcers. However, the data in this regard are sparse. So, the efficacy and safety of pentoxifylline in oral route was systematically reviewed to elucidate its effects on the size and number of ulcers, as well as the healing time and recurrence frequency in Recurrent Aphthous Stomatitis (RAS) patients. PubMed (Medline), Web of Science, Scopus, ScienceDirect, Cochrane Library, ProQuest, and Clinicaltrial.gov were searched for related articles. The investigated outcomes were pain level, the size and number of ulcers, the frequency of recurrence, the healing time, and finally the pentoxifylline related side effects. Only 6 related study that investigate the efficiency of Pentoxifylline on RAS (n =107) were identified. Decreasing in the pain level, improving the ulcer size and number were established in approximately all studies. Pentoxifylline established its ability to shorten the healing time of this type of mouth ulcers. However, its potential to prevent the recurrence of the disease could not establish based the data presented here. In conclusion, this systematic review suggests pentoxifylline in RAS patients because it confirmed that RAS patients who received this agent as oral administration reported suitable response. However, conducting more clinical trials with larger sample size and long follow-up time especially to efficiently judge about its ability to the recurrence prevention still is necessary to develop clinical practice guidelines for management of RAS.

Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer.

ObjectiveThe aim of this study is to analyze the microbiological characteristics of diabetic foot ulcer (DFU) and drug resistance of multidrug-resistant organisms (MDROs) and to reveal the potential risk factors for MDROs. This provides a basis for early empiric antibiotic treatment.MethodsThis study included 348 patients with diabetic foot ulcer in Chu Hsien-I Memorial Hospital & Metabolic Disease Hospital of Tianjin Medical University between May 2020 and November 2021. A total of 475 strains of bacteria were cultured, among which 240 strains were multidrug-resistant bacteria, accounting for 51%. Binary logistic regression was used to analyze risk factors. First, univariate analysis was used to calculate the p value of variables, and then multivariate analysis was conducted for variables with p < 0.1 to analyze independent risk factors. Risk factors with p < 0.05 in multivariable analysis were considered as independent risk factors. The strength of the association was represented by odds ratio and 95% confidence interval.ResultsUnivariable logistic regression analysis demonstrated that previous hospitalization, previous antibiotic therapy, ulcer size >4cm2, surgical therapy, D-dimer, and CRP were associated with MDRO infection in patients with DFU. Multivariate logistic regression analysis demonstrated that previous hospitalization (OR = 1.91; 95% CI = 1.11–3.28; p = 0.02), ulcer size >4cm2 (OR = 1.68; 95% CI = 1.03–2.76; p = 0.04), surgical therapy (OR = 2.14; 95% CI = 1.03–4.47; p = 0.04), and CRP (OR = 1.01; 95% CI = 1.00–1.01; p = 0.03) were independent risk factors for MDROs infection in diabetic foot patients. Drug resistance analysis may indicate that the proportion and drug resistance rate of Acinetobacter baumannii in Tianjin, China, have changed.ConclusionPrevious hospitalization, ulcer size >4cm2, surgical therapy and CRP were independent risk factors for MDROs infection in diabetic foot patients. Identifying these risk factors can help us identify the high-risk patients of diabetic foot with MDRO infection early. More attention to high-risk patients and more aggressive isolation precautions may reduce the incidence of MDRO infection in diabetic foot patients.

On the peculiarities of preparation of patients with venous trophic ulcer in outpatient conditions for the performance of radiofrequency ablation of veins

Annotation. The number of patients with venous trophic ulcer is constantly growing. At the same time, there is no effective method of their treatment in outpatient conditions. This issue is of fundamental importance for reducing the period of preparation of patients for radiofrequency ablation (RFA)of varicose veins. The aim of the study. The purpose of the study was: to give a clinical justification for the use of ultrasound debridement, PRP and PRF therapy to stimulate the regeneration process in venous ulcers in outpatient settings, for the aim of prepare patients for the implementation of RFA varicose veins. Under observation were 75 patients with varicose veins of the lower extremities in the stage of decompensation (C6 according to the CEAP classification). There were 49 women, 26 men, 55±4.6 years old. The duration of existence of venous ulcers was 2.1±06 years. The average size of ulcers is 4.5±1.7 cm. Ultrasound debridement was used to purify venous ulcers from necrotic masses, followed by stimulation of the regeneration process in them through PRP and PRF therapy. Thanks to the use of ultrasound debridement, it was possible to translate the chronic inflammatory process into an acute one. So, after the first session of ultrasound debridement, the wounds are regenerative and inflammatory in nature, which is confirmed by their cytological examination. Further use of PRP and PRF as a local factor in stimulating the regeneration process in venous ulcer caused the transition of regenerative-inflammatory to regenerative type of ulcer healing. Thanks to this approach to the treatment of venous ulcers, it was possible to reduce the time for surgical training of patients by 1.87 times. Treatment of venous ulcers, including ultrasound debridement – stimulation of the wound process PRP and PRF followed by operations aimed at eliminating the causes of decompensated chronic insufficiency is a promising direction in the treatment of varicose veins in outpatient settings.

The Effect of Topical Cow's Milk on the Healing of Diabetic Foot Ulcers: A Randomized Controlled Pilot Clinical Trial.

Diabetic foot ulcer (DFU) is a very serious side effect among the diabetic patients with substantial clinical and economic consequences. The aim of this study was to investigate the efficacy of cows' milk topical ointment, as an available and cost-effective natural product, on accelerating the healing of DFU. In this randomized controlled clinical trial, patients with grade 1 or 2 DFU were randomly divided into two groups of intervention (n = 50) and control (n = 49). For patients of intervention group, cows' milk 20% topical ointment was applied on the ulcer once daily for two weeks, while a type of novel dressing was used for control group with the same frequency and duration. Both groups received usual standard wound care measures. The percentage of change in the ulcer size and the number of cases with complete wound healing (>90% reduction in the ulcer size) were recorded in the both groups. The ulcer size significantly reduced in both groups on the seventh and 14th days of intervention; however, the percentage of reduction was significantly higher in the intervention (milk) group compared to control at both time points (44.64 ± 15.98 vs. 24.95 ± 12.78, P < .001; 67.67 ± 22.15 vs. 42.87 ± 19.74, P < .001). Furthermore, although more patients in the intervention group (n = 4, 8%) showed complete healing of the ulcer compared to control (n = 0), the difference was not statistically significant (P = .117). Cow's milk 20% topical ointment improves and accelerates the healing of diabetic foot ulcers. However, more clinical studies are required to confirm these effects.

Analysis of risk factors for multidrug-resistant organisms in diabetic foot infection

BackgroundTo study the bacteriological characteristics, risk factors, and treatment of multi-drug resistance (MDR) organisms in patients with diabetic foot infection.MethodsPatients with diabetic foot ulcer admitted to hospital from June 2018 to December 2019 (n = 180) were selected as clinical subjects. Demographic information, routine blood test, wound culture and sensitivity were collected. Risk factors of MDR bacteria were analyzed.ResultsAmong 180 patients with diabetic foot ulcer, 146 were positive in bacterial culture, with 84 positive in MDR bacteria. A total of 182 strains were isolated, with 104 strains being multi-drug resistant. Body mass index, glycosylated hemoglobin, fasting blood glucose, triglyceride, course of ulcer, size of ulcer, peripheral neuropathy, peripheral vascular disease, osteomyelitis, peripheral blood leukocyte count, percentage of neutrophils, and previous use of antibiotics were the related factors of infection of MDR bacteria in diabetic foot ulcer patients (P < 0.05). The leukocyte count and neutrophil ratio of MDR-bacilli were lower than those of non MDR-bacilli (P < 0.05).ConclusionThe risk of MDR bacteria in diabetic foot infection is high. It is necessary to evaluate the risk of multidrug-resistant bacteria by characterizing the course of disease, metabolic control, local ulcer and other aspects in order to formulate an effective treatment plan. The decrease of leukocyte count and neutrophil ratio may be related to damage of the host immune response.