Ulcer Size Research Articles

447-P: The Efficacy and Safety Trial of ENERGI-F703 in Diabetic Wound Healing: A Randomized, Double-Blind, Placebo-Controlled, Phase 2 Clinical Trial

Diabetic foot ulcers (DFUs) is a catastrophic ailment that exerts serious medical and psychological impact on diabetic patients. ENERGI-F703 is a hydrogel containing 0.02% adenine as a prodrug for the replenishment of cellular ATP levels to accelerate diabetic wound healing. To demonstrate its efficacy and safety in patients with DFU, 141 patients with type 2 diabetes (T2D) ≥ 20 years old with HbA1c 6.5-12 % and intractable DFUs (Wagner grade 1-3 without active osteomyelitis) were enrolled, randomized 2:1 ENERGI-F703 group (67.4%) to vehicle group (32.6%) for 12 weeks. Most target ulcers were grade 2 (63.6%, N=84) and located mainly on the foot sole (30.3%, N=40) or toe (27.3%, N=36). The primary endpoint was complete ulcer closure rate at the end of treatment. Secondary endpoints included the time required to complete ulcer closure, the accumulated confirmed ulcer closure rate and percentage change in ulcer size at each of the post-treatment visit, and adverse event incidence. Patients with confirmed complete ulcer closure were follow-up for additional 12 weeks and patients with incomplete ulcer closure were additional 4 weeks. An intend-to-treat (ITT) population of 132 subjects and a per-protocol (PP) population of 107 were included in efficacy analyses. Among the PP population with Wagner grade 1 or 2 target ulcers, we observed a significantly higher response rate in the ENERGI-F703 group compared to the vehicle group (48.0% vs. 20.8%, P = 0.0250). Among the ITT population, we also observed a higher response rate in the ENERGI-F703 group compared to the vehicle group (40.3% vs. 20.7%, P = 0.0656). Time to complete target ulcer closure was also faster among patients receiving ENERGI-F703 Gel in both the ITT population (P = 0.0380) and PP population (P = 0.0180). There were no suspected unexpected serious adverse reactions observed throughout the study. Our study showed that ENERGI-F703 Gel is an effective and well-tolerated treatment for DFU. Disclosure G. Young: Employee; Self; Energenesis Biomedical Co., Ltd. J. Lin: Employee; Self; Energenesis Biomedical Co., Ltd. Y. Cheng: Employee; Self; Energenesis Biomedical Co., Ltd. H. Chen: None. C. Huang: Employee; Self; Energenesis Biomedical Co., Ltd.

Comparison of Safety and Efficacy of Intrastromal Injections of Voriconazole, Amphotericin B and Natamycin in Cases of Recalcitrant Fungal Keratitis: A Randomized Controlled Trial.

ObjectiveTo compare the safety and efficacy of intrastromal voriconazole (IS-VCZ), amphotericin B (IS-AMB) and natamycin (IS-NTM) as an adjunct to topical natamycin (NTM) in cases of recalcitrant fungal keratitis.DesignProspective randomized trial.SettingTertiary eye centre.ParticipantsSixty eyes of 60 patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50% of stroma, and not responding to topical NTM therapy for two weeks) were recruited.Methodspatients were randomized into three groups of 20 eyes, each receiving ISVCZ 50ug/0.1 mL, ISAMB, 5ug/0.1 mL and ISNTM 10ug/0.1 mL (prepared aseptically in ocular pharmacology). The patients in all three groups continued topical NTM 5% every four hours until the ulcer healed. Primary outcome measure was time taken till complete clinical resolution of infection, and secondary outcome measure was best corrected visual acuity (BCVA) at six months.ResultsAll three groups had comparable baseline parameters. The mean duration of healing was significantly better (p=0.02) in the ISNTM group (34±5.2 days) as compared to the ISVCZ group (36.1±4.8 days) and the ISAMB group (39.2±7.2 days). About 95%, 90% and 95% patients healed successfully in the ISVCZ, ISAMB and ISNTM groups, respectively. In terms of healing, deep vascularization was significantly greater in the ISAMB group (55%, p=0.02) when compared to the ISVCZ and ISNTM groups (31% and 26%, respectively). There were fewer repeat injections in the ISNTM group (7/20 vs 8/20 and 9/20 in the ISVCZ and ISNTM groups, respectively).ConclusionIntrastromal injections are a safe and effective adjunct to conventional therapy in the management of recalcitrant fungal keratitis. ISNTM had a similar visual outcome with faster healing while ISAMB had a higher rate of deep vascularization after healing.

Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia.

Diabetic foot ulcer (DFU) is a common chronic complication of type 2 diabetes mellitus (T2DM) in Indonesia, with a prevalence of 7.3%. However, the characteristics of these patients remain unclear. We investigated the characteristics of patients with DFU without peripheral arterial disease (PAD) and analyzed non-vascular factors related to severity of DFU in a tertiary care national referral hospital in Indonesia. This was a cross-sectional study including 123 hemodynamically stable DFU patients without PAD recruited from Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia from 2010-2015. DFU patients were predominantly over 50years old (75.6%) and diagnosed with T2DM for 5years with poor glycemic control (82.7%) and peripheral neuropathy (91.3%). Most patients had anemia (86.7%), leukocytosis (84.6%), and were undernourished, as characterized by a low lipid profile (90.8%) and hypoalbuminemia (83.7%). Most had extensive size of ulcer at the initial visit, with a median size of 16.23 (2.92-60.16) cm2. Ulcers were mostly located of the forefoot (62.5%) and were caused by mechanical trauma (46.2%). Bivariate analysis revealed that significant factors for the development of DFU were related to DFU size, including duration of T2DM (p = 0.04), leukocyte levels (p = < 0.01), and thrombocyte levels (p = < 0.01). Multivariate analysis showed leucocyte (p = 0.03) and thrombocyte (p = 0.023) had significantly correlated with DFU severity. Leucocyte and thrombocyte may be the greatest contributing non-vascular factors for severity of DFU in Indonesia.

A COMPARATIVE STUDY BETWEEN THE EFFECTIVENESS OF AUTOLOGOUS PLATELET-RICH FIBRIN VERSUS SALINE DRESSING IN THE MANAGEMENT OF CHRONIC VENOUS LEG ULCERS

Background: Venous disease is responsible for around 85% of all chronic lower limb ulcers in resource-rich countries. Venous leg ulcer is a chronic condition, and various treatment modalities are available. Various adjunctive wound care therapies and procedures are available that can be utilized as part of a comprehensive approach to healing venous stasis ulcers. Platelet-rich brin (PRF) is one of the newer modalities and it contains broblast growth factor (FGF), VEGF, angiopoietin and platelet-derived GF which enhances the wound healing. We conducted a randomized controlled trial to compare the efcacy of PRF versus saline dressing in chronic venous leg ulcers. Aim: To compare the efcacy of autologous PRF with saline dressing in patients with chronic venous leg ulcer in terms of mean reduction in ulcer area, presence of infection and cosmetic outcome at the end of 4 weeks. Materials and Methods: Thirty patients with chronic venous leg ulcers of &gt;6 months duration having an ulcer area of 1 cm × 1 cm to 5 cm × 5 cm were taken into the study and were randomly divided into two groups. Group 1: Patients received PRF dressing. 10 mL of patient's blood was taken and centrifuged at 3000 rpm for 15 min. A brin clot obtained in the middle of the tube was removed and used for dressing over the wound surface. It was repeated every week for 4 weeks. Group 2: Patients received saline dressings once a week for 4 weeks. The assessment of the ulcer size was done with the help of photographs, and ulcer area was measured. Results: The mean reduction in the area of the ulcer size in PRF group was 81.84%, and the mean reduction in the area of the ulcer size in Saline group was 59.84%. Conclusion: Platelet rich brin matrix is a novel modality and an ideal, safe, affordable therapeutic option for chronic venous leg ulcers.

AUTOLOGOUS SUCTION BLISTER EPIDERMAL GRAFTING FOR CHRONIC LEG ULCERS

Non healing ulcers are a burden to the patient as they are difcult to treat. They also affect patient's quality of life. A series of 2 patients – one with chronic venous ulcer and other with diabetic foot ulcer were included. Epidermal grafts were harvested and applied using Cellutome epidermal harvesting system (KCI) with no anesthesia. After transferring the harvest of epidermal blisters, 4 layer compression bandaging was given. Both the patients tolerated the procedure with no complications involving donor as well as recipient sites. Photographs were taken during various phases of healing. 1 week follow up showed 63% reduction in wound area. Donor site was completely healed by this time. Reduction in ulcer size of upto 99% was seen in 8 weeks.

OP02 Ustekinumab versus adalimumab for induction and maintenance therapy in Moderate-to-Severe Crohn’s Disease: The SEAVUE study

Abstract Background We studied the efficacy and safety of ustekinumab (UST) vs adalimumab (ADA) through 1 year in biologic-naïve patients (pts) with moderate-to-severe Crohn’s disease. Methods SEAVUE was a multicenter, randomized, blinded, parallel-group, active-controlled study in adults with CD Activity Index (CDAI) scores ≥220/≤450. Biologic-naïve pts failing/intolerant to conventional therapy with any size ulcer on baseline (BL) ileocolonoscopy were eligible. Pts were randomized 1:1 to UST (⁓6mg/kg IV at BL then 90mg SC every 8 weeks [Ws]) or ADA (160/80mg SC at BL/W2, then 40mg SC every 2 Ws) per US-approved regimens (no dose modifications). Primary endpoint was clinical remission at W52 (CDAI &amp;lt;150). Major secondary endpoints were corticosteroid-free remission, clinical response (≥100-point CDAI decrease from BL), remission in pt-reported CDAI components (PRO-2 symptom remission: abdominal pain mean daily score ≤1 and stool frequency mean daily score ≤3), and endoscopic remission (SES-CD score ≤3/0 for pts with BL score=3) at W52 and clinical remission at W16. Results 386 pts were randomized to UST or ADA. BL demographics and disease characteristics were balanced between groups and indicative of pts with early, moderate-to-severe CD (median CD duration, 2.58 years; CDAI, 289.5; SES-CD, 8.0). At W52, 65% of UST-treated and 61% of ADA-treated pts achieved clinical remission (Δ=4.0%; 95% CI, -5.5%, 13.5%; p=0.417). Major secondary endpoints, including endoscopic remission, were similar between groups (Table 1), as were remission rates at assessment points through W52. Some other secondary endpoints showed numerical (not statistical) differences between UST and ADA (Table 1). Key safety events are summarized in Table 2. Among UST-treated and ADA-treated pts, 34.0% and 40.5% had infections, 2.6% and 7.2% had serious adverse events (AEs) of worsening CD, and 6.3% and 11.3% had AEs that led to discontinuation (DC) of study drug, respectively. One ADA-treated pt had active pulmonary TB. Injection-site reactions associated with active treatment occurred in 1.0% of UST-treated and 10.3% of ADA-treated pts. Overall, 15.2% of UST-treated and 23.6% of ADA-treated pts DC before W52. Reasons for DC were primarily lack of efficacy (UST, 2.1% vs ADA, 5.1%), AEs (UST, 5.7% vs ADA, 10.7%), and withdrawal of consent (UST, 5.8% vs ADA, 5.1%). Time to treatment DC was longer with UST vs ADA (post hoc analysis). Conclusion Both UST and ADA were highly effective in this population of biologic-naïve pts. Rates of clinical remission at W52 were not statistically significantly different between treatment groups. DC rates were numerically lower for UST. Safety results were consistent with prior experience for both treatments.

English

BACKGROUND Treatment of fungal ulcers is one of the most challenging tasks. Various topical antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad spectrum drug and is an effective agent for the treatment of fungal keratitis as a topical preparation. It is potent against a broad range of clinically significant fungal infections both in the eye as well systemically. In tropical climatic conditions filamentous fungi commonly cause eye infections and are associated with poor visual outcomes. The treatment options for mycotic ulcers are limited, therefore direct intrastromal injections are helpful in the management of these deep mycotic keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole in the management of deep fungal keratitis not responding to conventional therapy. METHODS This an interventional case series study done at a tertiary care centre in south India from the year April 2019 to August 2020. Eight eyes of eight patients with microbiologically proven deep stromal recalcitrant mycotic keratitis not responding to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1 ml was injected around the infiltrate in the corneal stroma as an adjunctive to the topical antifungal treatment. Main outcome measure was a reduction of the size of the infiltrate and ulcer and decrease in infection on regular follow ups. RESULTS Before injecting voriconazole, all the cases were of either gradually worsening of lesions on topical treatment, or not responding to topical treatment. After the injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration was seen within 3 weeks. CONCLUSIONS Targeted delivery of intrastromal voriconazole may be a safe and effective way in the management of deep seated fungal ulcers which respond poorly to conventional treatment procedures, thus reducing the need for further surgical treatment. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis

Comprehensive Analysis of Cell Therapy on Chronic Skin Wound Healing: A Meta-Analysis.

Wound healing has been greatly challenging in different acute and chronic skin injuries. Among them, nonrevascularizable critical limb ischemic ulcers, venous leg ulcers, and diabetic lower limb or extremity ulcers are well-known refractory skin injuries that are difficult to treat. Partly differentiated, progenitor cell-based graft transplantation or direct injection of autologous stem cells might promote the wound healing process. Studies aiming to comprehensively analyze the effects of cell therapy on skin wound healing could provide clinical evidence for skin injury treatment. Different databases were searched for full-text publications on the comparison between cell therapy and regular therapy. Heterogeneity was detected by the I2 method, and a fixed effect model was applied for data pooling if heterogeneity was absent. Publication bias was analyzed using a funnel plot, and 10 studies were finally included in this study. After a long-term follow-up, fewer patients underwent major amputation in the cell therapy group, compared with the standard therapy group, and those in the cell therapy group were characterized by a smaller ulcer area. Moreover, there was a significant difference in the wound healing rate between the intervention and control groups. However, pain caused by skin wounds was hardly mitigated by cell therapy in patients with critical limb ischemia. In this study, cell therapy proved effective in decreasing the size of ulcers and improving the wound closure rate. Additionally, the major amputation rate was decreased in the cell therapy group. However, the symptoms of pain were hardly alleviated by cell therapy in patients with cutaneous ulcers caused by peripheral artery disease-related critical limb ischemia.

Bacteriological profile and antimicrobial sensitivity pattern of isolates from diabetic foot of patients attending a teaching hospital in Northern India

Background: Diabetic foot ulcer is a major cause for diabetes related morbidity and hospitalization. Up to one-third of people with diabetes develop diabetic foot ulceration (DFU) during their lifetime and over 50% of these ulcerations become infected. Diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, high costs, increased risk of lower extremity amputation (LEA), and reduced quality of life.&#x0D; Aims and Objective: The current study was conducted to determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers patients at a tertiary care center in Srinagar province.&#x0D; Material and Methods: This was a Cross-sectional, observational study conducted in diabetic patients with diabetic foot infection, randomly selected from outpatient departments (OPDs) and wards of Surgery and Medicine department, with Wagner grade 1-5 ulcers and irrespective of anti-diabetic treatment and diabetic foot injury treatment. Samples were processed and bacterial isolates were identified by standard microbiological procedures.&#x0D; Results: After following inclusion and exclusion criteria, 120 patients were considered for this study. In present study most common age group was 51-60 years age group (44%) followed by 41-50 years (32%). 66% of participants were males. 55% patients had diabetes for more than 10 years. 43% patients had ulcer size less than 5 cm2. The most common category as per Wagner’s classification was Grade 1, which comprised of 48% of study participants, followed by Grade 0 (28%) and Grade 2 (18%). Grade 3 and above comprised 7% of cases. Of the 120 study participants, 103 (86%) showed growth on culture. Among these 62 (60%) showed mono-microbial growth with 41 cases showing mixed growth. The most commonly isolated bacteria were Methicillin Resistant Staphylococcus aureus (MRSA) (23%), Coagulase Negative Staphylococci (CoNS) (18%), pseudomonas aeruginosa (18%), Methicillin Sensitive-Staphylococci Aureus (9%), Klebsiella Pneumoniae (9%), and Escherichia Coli (8%). Linezolid, vancomycin, clindamycin, gentamicin were most effective antimicrobial agents against gram positive bacteria. Iimipenem, piperacillin tazobactam, cefoperazone sulbactam &amp; gentamicin were most effective antimicrobial agents against gram negative bacteria.&#x0D; Conclusion: Early microbiological evaluation for bacteriological profile, the nature of the infection either monomicrobial or polymicrobial and antibiotic sensitivity testing can improve treatmentoutcome, reduces complications, morbidity as well as multidrug resistance.

Topical oxygen therapy in the treatment of diabetic foot ulcers: a multicentre, open, randomised controlled clinical trial.

Perfusion and blood oxygen levels are frequently insufficient in patients with hard-to-heal wounds due to poor circulation, vascular disruption and vasoconstriction, reducing the wound's capacity to heal. This study aimed to investigate the effect of topical oxygen on healing rates in patients with hard-to-heal diabetic foot ulcers (DFUs) (i.e., non-responsive over four weeks). This multicentre, open-label, community-based randomised clinical trial compared standard care (SOC) with or without continuous topical oxygen therapy (TOT) for 12 weeks in patients with DFUs or minor amputation wounds. SOC included debridement, offloading with total contact casting (TCC) and appropriate moisture balance. Primary endpoints were the number of patients to achieve complete wound closure and percentage change in ulcer size. Secondary endpoints were pain levels and adverse events. For the study, 145 patients were randomised with index ulcers graded Infectious Diseases Society of America (IDSA) 1 or 2, or Wagner 1 or 2. In the intention-to-treat analysis, 18/64 (28.1%) patients healed in the SOC group at 12 weeks compared with 36/81 (44.4%) in the SOC plus TOT group (p=0.044). There was a statistically significant reduction in wound area between the groups: SOC group mean reduction: 40% (standard deviation (SD) 72.1); SOC plus TOT group mean reduction: 70% (SD 45.5); per protocol p=0.005). There were no significant differences in changes to pain levels or adverse events. This study suggests that the addition of TOT to SOC facilitates wound closure in patients with hard-to-heal DFUs.

TO EVALUATE THE EFFICACY OF INTRASTROMAL INJECTION OF VORICONAZOLE IN RESISTANT CASES OF FUNGAL CORNEAL ULCER

Purpose: To evaluate the efficacy of intrastromal injection of voriconazole in resistant cases of fungal corneal ulcer. Methods: 25 cases of fungal corneal ulcer were diagnosed on the basis of clinical findings and KOH staining between July 2019 to July 2020 in NMCH, Sasaram, Bihar. They were treated with topical natamycin (5%) and voriconazole (1%). 6 cases that did not improve; judged clinically by increasing size of ulcer and clinical signs; were subjected to intrastromal voriconazole (50mcg/0.1ml) around ulcer in 4 meridians. Observation and result: 3 cases improved clinically and rest 3 cases which did not improve were referred for therapeutic keratoplasty. Conclusion: In resistant cases of fungal corneal ulcer intrastromal injection of voriconazole can be tried.

Endoscopic Hemostasis and Its Related Factors of Duodenal Hemorrhage

Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.

Propranolol for the treatment of ulcerated infantile hemangiomas: A prospective study

Propranolol for the treatment of ulcerated infantile hemangiomas: A prospective study

Vacuum-assisted accelerated healing of postphlebitic ulcer

Background Chronic leg ulcers affect ∼1% of the adult population in developed countries. The cornerstones of these regimens are compression therapy and resolution of the cause. Topical negative pressure has been used to promote the healing of tissue defects. The aim of our study is to evaluate the efficacy of vacuum assisted compression (VAC) in ulcer healing. Patients and methods After the ethics committee’s institutional review board (IRB) under number MS.17.06.09, this prospective randomized controlled study was conducted on 30 patients presented to the Vascular Surgery Department between June 2017 and October 2018. The patient was randomly allocated into three groups; each group contained 10 patients: one group underwent conventional therapy, the second group underwent VAC therapy, and the third underwent combined VAC and conventional therapies. These groups were compared regarding ulcer size, presence of granulation tissue, and presence of infection. The VAC system was placed in situ for 3 weeks, and the dressing was changed every 5 days. Patients were evaluated clinically through follow-up clinic visits at first week, the second week, 1 month, and 3 months after the procedure, regarding depth, width, and breadth and ulcer closure percentage. Results The current study shows that compression plus VAC group had a statistically significant faster closure duration than other compression groups (P 0.05). Cases that were lost to follow-up were 10, 20, and 20% in the compression group, VAC group, and combined group. Conclusion Healing of venous ulcers is a complex process attributed to several elements. Although various parameters proved to positively affect the healing of venous ulcers in our study, large prospective multicenter studies are needed to provide well-defined outcomes.

Efficacy of 5% Tea Tree Oil Hydrogel on Healing Morbus Hansen's Chronic Plantar Ulcer

Background: The damage of the peripheral nerves that occurs in Morbus Hansen (MH) patients can cause disability due to loss of sensory, motor and autonomic functions can cause wounds, infections, ulcers and disability. Ulcers are the most common cause of disability complications in MH patients and requires a certain time of healing. As many as 10-20% of MH patients experience ulcers on the soles. Tea Tree Oil (TTO) is extracted from steam distillation of the leaves and twigs of the Australian native shrub Melaleuca Alternifolia. In ulcers, TTO can work as an antimicrobial, anti-inflammatory, and antioxidant. TTO preparation in the form of hydrogel is believed to help the wound healing process. Purpose: To investigate the effect of TTO hydrogel 5% on the healing of Chronic Plantar Ulcer of Leprosy (CPUL). Methods: Tea tree oil hydrogel 5% was applied every 3 days for up to 8 weeks in 22 subjects with chronic MH plantar ulcers. Ulcer size, side effects, and possible side effects are evaluated weekly. Result: There were significant clinical and statistical differences in ulcer size (p = 0.000) and in ulcer depth (p = 0.000) after TTO hydrogel 5%. No side effects occurred in this study. The ulcer healed was 59%, the ulcer improved by 36.4%, the persistent ulcer was 4.6%, and there was no ulcer that got worse. Conclusion: TTO hydrogel 5% is effective in the healing process of chronic MH plantar pedis ulcers.

Construction and Validation of a Risk-Scoring Model that Preoperatively Predicts Lymph Node Metastasis in Early Gastric Cancer Patients.

The aim of this study was to create a risk-scoring model to preoperatively predict the incidence of lymph node metastasis (LNM) in early gastric cancer (EGC) patients to guide treatment. To construct the risk-scoring model, we retrospectively analyzed a primary cohort of 548 EGC patients. Univariate analysis and logistic regression were performed. A risk-scoring model for predicting LNM in EGC patients was developed based on preoperative factors, and another cohort of 73 patients was then analyzed to validate the model. In the primary cohort, LNM was pathologically confirmed in 72 (13.1%) patients. In the multivariate analysis, the presence of ulceration and tumor size on gastroscopy, undifferentiated histological type, and presence of enlarged lymph nodes on computed tomography or endoscopic ultrasonography were independent risk factors for LNM. A 17-point risk-scoring model was developed to predict LNM risk. The cut-off score of the model was 8, and the area under the receiver operating characteristic curve (AUC) of the model was 0.835 [95% confidence interval (CI) 0.784-0.886]. In the validation cohort, the AUC of the model was 0.829 (95% CI 0.699-0.959). We developed and validated an effective 17-point risk-scoring model that could preoperatively predict LNM for EGC patients.

EFFECTIVENESS OF THE BARK DREDGING OF THE JAVA WOOD TREE (LANNEA COROMANDELICA) ON THE DIABETIC ULCER HEALING PROCESS

Background: Diabetic ulcer is a micro vascular complication that can be experienced by all DM patients. This condition necessitates appropriate wound care management to prevent infection, reduce necrotic tissue, and enhance the wound healing process. This study aims to determine the effect of using Javanese tree bark scraping on the healing process of diabetic ulcers, namely changes in the size of diabetic ulcers.&#x0D; Methods: This type of research is a Quasy Experiment with a Pre-test Post-test approach with control group. The populations in this study were all diabetic ulcer patients who came for wound care at Puskesmas Puuwatu totaling 16 respondents.&#x0D; Result: The results of statistical tests show that the p-value for the intervention group is 0.317 and the control group is 1,000, which means that there is no difference in wound size before and after the intervention in the intervention group and the control group. In the Mann Whitney statistical test, it was found that the p-value in the intervention group was 0.189, which is greater than the value of ? = 0.05.&#x0D; Conclusion: The dredging of the bark of the Java tree is not effective against changes in wound size in patients with diabetic ulcers.

Predicting endoscopic remission in Crohn’s disease by the modified multiplier SES-CD (MM-SES-CD)

Background and aimsThe Simple Endoscopic Score for Crohn’s disease (SES-CD) is the primary tool for measurement of mucosal inflammation in clinical trials but lacks prognostic potential. We set to develop...

FEATURES OF THE DYNAMICS OF THE I DEGREE OF SEVERETY BACTERIAL KERATITES IN DIABETIC PATIENTS

Summary. Diabetes mellitus (DM) is a risk factor for severe bacterial keratitis, which often leads to complications.&#x0D; The aim was to identify the features of the dynamics of the I degree of severity bacterial keratitis in diabetic patients.&#x0D; Materials and methods. The results of treatment of 15 patients with type 1 DM and bacterial keratitis of the I degree of severity (main group) and 20 patients with bacterial keratitis of the I degree of severity without DM (control group) were analyzed. The severity of bacterial keratitis was determined according to our proposed scheme with a total score of ≤ 14. All patients were treated with instillations of ofloxacin, antiseptics, antioxidants, reparents, artificial tears, mydriatics, systemic anti-inflammatory therapy. In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye, non-contact corneal esthesiometry.&#x0D; Results and discussion. In diabetic patients with bacterial keratitis of the I degree of severity the degree of inflammatory reaction in the anterior chamber of the eye and the average threshold of corneal sensitivity at all airflow temperatures at the first visit exceeded the indicators of controls (p&lt;0.05). The degree of the average corneal sensitivity threshold decrease throughout the observation, the degree of pericorneal injection, the size of the corneal ulcer, the depth of corneal infiltration from the 3rd day of observation, the depth of corneal ulcer and corneal edema from the 7th day exceeded indicators of controls (p&lt;0.05).&#x0D; Conclusions. Diabetic patients have features of the dynamics of the I degree of severity bacterial keratitis, which lead to prolongation of the disease and worsening of its consequences.

Isolation and Identification of Staphylococci and Pseudomonas from Diabetic Foot Ulcer in Perambalur District Hospitals in Tamil Nadu

Diabetic foot ulcers are still a problem for the health care system and are majorly influencing quality of life. Infected foot ulcer is one of the most feared complications of diabetes mellitus, leading to gangrene and it needs to be amputed. Diabetic foot lesions are major medical, social and economic problem and leading cause of hospitalization for patients with diabetes worldwide. The risk of a diabetic patient for developing a foot ulcer was estimated to be ~25%. Samples were collected from 65 infected patients of diabetic foot ulcer male and female. The mean age group was found to be 40-80 years with the clinical history such as age, sex, types of diabetes duration of diabetes, size of ulcer and duration of ulcer were observed and recorded. The Specific mediums were used for the isolation and identification using classical methods based on their morphology, Grams stain reaction, oxidase and catalase tests were performed to confirm the isolates were both gram-negative and gram-positive organisms Bergey’s manual of Determinative Bacteriology. Further, MALDI- TOF (Matrix-Assisted Laser Desorption/Ionization) was used to confirm the isolates identified in classical methods were Staphylococci (79%) and Pseudomonas (21%) In this study Among 68 isolates, identified in out of 41 isolates Pseudomonasaeruginosa (21%) Staphylococcus aureus (54%) Staphylococcus hominis (20%)and Staphylococcous hemolytic(5%). Although in gram positive organism Staphylococcus aureus (54%) was the most predominant isolate found in diabetic foot ulcer.