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Das M, Mondal S, Ghosh R, Darbar S, Roy L, Das AK, Pal D, Bhattacharya SS, Mallick AK, Kundu JK, Pal SK. A study of scarless wound healing through programmed inflammation, proliferation and maturation using a redox balancing nanogel. J Biomed Mater Res A 2024; 112:1594-1611. [PMID: 38545912 DOI: 10.1002/jbm.a.37712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 07/12/2024]
Abstract
In the study, we have shown the efficacy of an indigenously developed redox balancing chitosan gel with impregnated citrate capped Mn3O4 nanoparticles (nanogel). Application of the nanogel on a wound of preclinical mice model shows role of various signaling molecules and growth factors, and involvement of reactive oxygen species (ROS) at every stage, namely hemostasis, inflammation, and proliferation leading to complete maturation for the scarless wound healing. While in vitro characterization of nanogel using SEM, EDAX, and optical spectroscopy reveals pH regulated redox buffering capacity, in vivo preclinical studies on Swiss albino involving IL-12, IFN-γ, and α-SMA signaling molecules and detailed histopathological investigation and angiogenesis on every stage elucidate role of redox buffering for the complete wound healing process.
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Affiliation(s)
- Monojit Das
- Department of Zoology, Vidyasagar University, Midnapore, India
- Department of Zoology, Uluberia College, University of Calcutta, Howrah, India
| | - Susmita Mondal
- Department of Chemical, and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata, India
| | - Ria Ghosh
- Department of Chemical, and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata, India
- Department of Biochemistry, University of Calcutta, Kolkata, India
| | - Soumendra Darbar
- Research and Development Division, Dey's Medical Stores (Mfg.) Ltd, Kolkata, India
| | - Lopamudra Roy
- Department of Applied Optics and Photonics, University of Calcutta, Kolkata, West Bengal, India
| | - Anjan Kumar Das
- Department of Pathology, Coochbehar Government Medical College and Hospital, India
| | - Debasish Pal
- Department of Zoology, Uluberia College, University of Calcutta, Howrah, India
| | | | - Asim Kumar Mallick
- Department of Pediatrics, Nil RatanSircar Medical College and Hospital, Kolkata, India
| | | | - Samir Kumar Pal
- Department of Zoology, Uluberia College, University of Calcutta, Howrah, India
- Department of Chemical, and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata, India
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Natarajan J, Joseph MA, Al Alawi R, Al Bulushi T, Al Alawi I, Al Junaibi SM, Thanka AN, Al Balushi LD, Al Ismaili IS, Shummo M, Al Nabhani SST. A domain specific health-related quality of life of omani patients living with chronic wounds. J Tissue Viability 2024; 33:393-398. [PMID: 38762367 DOI: 10.1016/j.jtv.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/12/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
AIM Chronic wounds, defined as wounds that do not heal in a logical set of stages, impact patients' quality of life by disrupting their self-esteem, sleep, social interaction, work capacity, and psychological well-being. Chronic wounds are a prevalent problem in Oman due to the high number of patients with diabetes, sickle cell disease, road traffic accidents, and decubitus ulcer. Therefore, it is paramount to analyse the health-related quality of life (HRQOL) of these patients with chronic wounds. MATERIAL AND METHODS An observational, cross-sectional, descriptive study with a quantitative approach was conducted among 275 adult patients with chronic wounds in three tertiary hospitals of Muscat from June to December 2021 using a self-reported Cardiff life wound impact questionnaire and the Bates-Jensen wound assessment tool. Data were analysed with IBM SPSS version 23 using inferential statistics and chi-square test. RESULTS We found that the majority of participants were men (178; 64.7 %), aged between 41 and 60 years (107; 38.9 %), predominantly with diabetic wounds (80; 29.1 %). Respondents reported poor HRQOL across all domains: well-being (63.24 ± 18.092), physical (53.24 ± 18.387), and social (59.54 ± 19.025). Statistically significant poorer HRQOL was observed among the elderly above 60 years, illiterates, those with traumatic wounds, and those receiving medication and dressing as treatment. CONCLUSIONS Our findings indicate that Omani patients with chronic wounds experience low HRQOL. It is imperative for healthcare providers to offer comprehensive care to these patients. To enhance their quality of life and alleviate suffering, evaluating both the wounds and HRQOL is essential. Such assessments will enable the optimisation of treatment and coping strategies for patients.
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Affiliation(s)
- Jansirani Natarajan
- School of Health in Social Science, The University of Edinburgh, Scotland, United Kingdom
| | - Mickael Antoine Joseph
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Rashid Al Alawi
- Surgery Department, Royal Hospital, Muscat, Sultanate of Oman
| | - Taimoor Al Bulushi
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | - Suad Moosa Al Junaibi
- Adult Health Nursing Department, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - Anitha Nesa Thanka
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | | | - Moath Shummo
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Gunasegaran N, Goh WT, Tan WX, Saipollah H, Chong HR, Sunari RN, Chong TT, Ang SY, Aloweni F. Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore. J Tissue Viability 2024:S0965-206X(24)00114-1. [PMID: 39164151 DOI: 10.1016/j.jtv.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 08/22/2024]
Abstract
AIM To examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. METHOD This was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two-or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). RESULTS Forty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. CONCLUSION This first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.
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Affiliation(s)
| | - Wee Ting Goh
- Nursing Division, Singapore General Hospital, Singapore.
| | | | | | - Hui Ru Chong
- Nursing Division, Singapore General Hospital, Singapore.
| | | | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore.
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore.
| | - Fazila Aloweni
- Nursing Division, Singapore General Hospital, Singapore.
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Natarajan J, Joseph MA, Alawi RA, Bulushi TA, Alawi IA, Junaibi SMA, Thanka AN, Balushi LDA, Ismaili ISA, Shumma M, Nabhani SSTA. Wellbeing, quality of life and satisfaction of patients with hard-to-heal wounds: a descriptive study. J Wound Care 2024; 33:526-532. [PMID: 38967342 DOI: 10.12968/jowc.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE A hard-to-heal wound is defined as a wound that failed to proceed through the normal phases of wound healing in an orderly and timely manner. The purpose of this article is to describe the impact of hard-to-heal wounds on the wellbeing, quality of life (QoL) and satisfaction with QoL of patients in Oman with hard-to-heal wounds. METHOD A descriptive cross-sectional study of patients with hard-to-heal wounds attending three tertiary care hospitals using a self-reported questionnaire was conducted. RESULTS A total of 275 patients took part in the study. Patients reported a low wellbeing score (67.06±19.72), moderate QoL score (52.18±25.07) and moderate satisfaction scores (68.91±23.88). Significant mean differences were reported with age, sex, educational level, monthly income and type of wound all at p<0.05. CONCLUSION The findings of this study demonstrated that hard-to-heal wounds could influence the wellbeing, QoL and overall satisfaction with QoL of patients. DECLARATION OF INTEREST Funding was received through an internal grant of the Sultan Qaboos University to conduct the research conducting the research (IG/CON/FACN/20/01). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Jansirani Natarajan
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mickael Antoine Joseph
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Rashid Al Alawi
- Surgery Department, Royal Hospital, Muscat, Sultanate of Oman
| | - Taimoor Al Bulushi
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | - Suad Moosa Al Junaibi
- Adult Health Nursing Department, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - Anitha Nesa Thanka
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | | | - Moath Shumma
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Payuhakrit W, Panpinyaporn P, Khumsri W, Yusakul G, Praphasawat R, Nuengchamnong N, Palipoch S. Enhancing chronic wound healing with Thai indigenous rice variety, Kaab Dum: Exploring ER stress and senescence inhibition in HaCaT keratinocyte cell line. PLoS One 2024; 19:e0302662. [PMID: 38748716 PMCID: PMC11095683 DOI: 10.1371/journal.pone.0302662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/05/2024] [Indexed: 05/19/2024] Open
Abstract
Kaab Dum, a prominent indigenous rice variety cultivated in the Pak Phanang Basin of Nakhon Si Thammarat, Thailand, is the focus of our study. We investigate the therapeutic potential of indigenous Kaab Dum rice extract in the context of chronic wounds. Our research encompasses an examination of the nutritional compositions and chemical profiles of Kaab Dum rice extract. Additionally, we assess how the extract affects chronic wounds in TGF-β-induced HaCaT cells. Our evaluation methods include the detection of cellular oxidative stress, the examination of endoplasmic reticulum (ER) stress, wound healing assays, analysis of cell cycle arrest and the study of cellular senescence through senescence-associated β-galactosidase (SA-β-gal) staining. Our research findings demonstrate that TGF-β induces oxidative stress in HaCaT cells, which subsequently triggers ER stress, confirmed by the expression of the PERK protein. This ER stress results in cell cycle arrest in HaCaT cells, characterized by an increase in p21 protein, a cyclin-dependent kinase inhibitor (CDKI). Ultimately, this leads to cellular senescence, as confirmed by SA-β-gal staining. Importantly, our study reveals the effectiveness of Kaab Dum rice extract in promoting wound healing in the chronic wound model. The extract reduces ER stress and senescent cells. These beneficial effects are potentially linked to the antioxidant and anti-inflammatory properties of the rice extract. The findings of our study have the potential to make significant contributions to the development of enhanced products for both the prevention and treatment of chronic wounds.
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Affiliation(s)
- Witchuda Payuhakrit
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Pathobiology Information and Learning Center, Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Wilunplus Khumsri
- Interdisciplinary Program of Biomedical Sciences, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Gorrawit Yusakul
- School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand
| | - Ratsada Praphasawat
- Department of Pathology, School of Medicine, University of Phayao, Phayao, Thailand
| | - Nitra Nuengchamnong
- Science Lab Centre, Faculty of Science, Naresuan University, Phitsanulok, Thailand
| | - Sarawoot Palipoch
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
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Iversen AKS, Fritz BG, Hansen MJ, Kirketerp-Møller K, Jakobsen TH, Bjarnsholt T, Lichtenberg M. Novel sampling technique maintaining the two-dimensional organization of microbes during cultivation from chronic wounds: The Imprint method. APMIS 2024; 132:210-220. [PMID: 38270387 DOI: 10.1111/apm.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Abstract
This study aimed to develop and validate "the Imprint method,", a technique for sampling microbes from chronic wounds while preserving their two-dimensional spatial organization. We used nylon filters to sample bacteria and compared with sampling using Eswabs in 12 patients. The Imprint method identified a mean of 0.93 unique species more than Eswab (4.3 ± 2.2 and 3.4 ± 1.4 unique species, respectively; mean ± SD; n = 30). Accuracy between the Eswab and the Imprint method was 93.2% and in cases of disagreement between methods, Imprint had a higher sensitivity in 6/8 of the most prevalent species. In vitro validation confirmed that the Imprint method could transfer bacterial colonies while replicating their two-dimensional organization and the area covered by bacteria on the plate sampled. Clinical testing demonstrated that the imprint method is a rapid and feasible technique that identified more unique bacterial species than Eswab with a good agreement between methods but that Imprint was better at detecting important pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa. The Imprint method is a novel technique that cultures and records the two-dimensional organization of microbes, providing an alternative or supplement to conventional surface culture using Eswab.
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Affiliation(s)
| | - Blaine Gabriel Fritz
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Mads Joachim Hansen
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Tim Holm Jakobsen
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mads Lichtenberg
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Wong A, Lai P, Chong HH, Lien CTC, Graves N. The Clinical and Cost-Effectiveness of an Individualized Nutritional CAre (INCA) Bundle versus Standard Care for Adults with Pressure Injuries Receiving Home Nursing Services: A Protocol for a Cluster Randomized and Pragmatic Clinical Trial with an Economic Evaluation. Nutrients 2024; 16:299. [PMID: 38257192 PMCID: PMC10819700 DOI: 10.3390/nu16020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pressure injuries (PIs) represent a significant healthcare challenge in Singapore among the aging population. These injuries contribute to increased morbidity, mortality, and healthcare expenditure. Existing research predominantly explores single-component interventions in hospital environments, often yielding limited success. The INCA Trial aims to address this research gap by conducting a comprehensive, cluster randomized controlled trial that integrates education, individualized nutritional support, and community nursing care. This study is designed to evaluate clinical and cost-effectiveness outcomes, focusing on PI wound area reduction and incremental costs associated with the intervention. METHODS The INCA Trial employs a two-group, non-blinded, cluster randomized, and pragmatic clinical trial design, recruiting 380 adult individuals (age ≥ 21 years) living in the community with stage II, III, IV, and unstageable PI(s) who are receiving home nursing service in Singapore. Cluster randomization is stratified by postal codes to minimize treatment contamination. The intervention arm will receive an individualized nutrition and nursing care bundle (dietary education with nutritional supplementation), while the control arm will receive standard care. The 90-day intervention will be followed by outcome assessments extending over one year. Primary outcomes include changes in PI wound area and the proportion of participants achieving a ≥40% area reduction. Secondary outcomes include health-related quality of life (HRQOL), nutritional status, and hospitalization rates. Data analysis will be conducted on an intention-to-treat (ITT) basis, supplemented by interim analyses for efficacy and futility and pre-specified sensitivity and subgroup analyses. The primary outcome for the cost-effectiveness analysis will be based on the change to total costs compared to the change to health benefits, as measured by quality-adjusted life years (QALYs). DISCUSSION The INCA Trial serves as a pioneering effort in its approach to PI management in community settings. This study uniquely emphasizes both clinical and economic outcomes and melds education, intensive dietetic support, and community nursing care for a holistic approach to enhancing PI management.
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Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Precilla Lai
- Department of Nursing, Home Nursing Foundation, 490 Lorong 6 Toa Payoh, #05-10, Singapore 310490, Singapore;
| | - Hui Hsien Chong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | | | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School Singapore, 8 College Road, Singapore 169857, Singapore
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Pöyry A, Kimpimäki T, Kaartinen I, Salmi TT. Quality registry improves the data of chronic ulcers: Validation of Tampere Wound Registry. Int Wound J 2023; 20:3750-3759. [PMID: 37293796 PMCID: PMC10588319 DOI: 10.1111/iwj.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Quality registries are potential tools for improving health care documentation, but the quality and completeness of each registry should be ensured. This study aimed to evaluate the completion rate (completeness) and accuracy of data, first contact-to-registration time (timeliness), and case coverage of the Tampere Wound Registry (TWR) to assess whether it can be reliably used in clinical practice and for research purposes. Data from all 923 patients registered in the TWR between 5 June 2018 and 31 December 2020 were included in the analysis of data completeness, while data accuracy, timeliness and case coverage were analysed in those registered during the year 2020. In all analyses values over 80% were considered good and values over 90% excellent. The study showed that the overall completeness of the TWR was 81% and overall accuracy was 93%. Timeliness achieved 86% within the first 24 h, and case coverage was found to be 91%. When completion of seven selected variables was compared between TWR and patient medical records, the TWR was found to be more complete in five out of seven variables. In conclusion, the TWR proved to be a reliable tool for health care documentation and an even more reliable data source than patient medical records.
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Affiliation(s)
- Anna Pöyry
- Department of DermatologyTampere University HospitalTampereFinland
| | - Teija Kimpimäki
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Ilkka Kaartinen
- Department of Musculoskeletal Surgery and DiseasesTampere University HospitalTampereFinland
| | - Teea T. Salmi
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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Probst S, Saini C, Gschwind G, Stefanelli A, Bobbink P, Pugliese M, Cekic S, Pastor D, Gethin G. Prevalence and incidence of venous leg ulcers-A systematic review and meta-analysis. Int Wound J 2023; 20:3906-3921. [PMID: 37293810 PMCID: PMC10588327 DOI: 10.1111/iwj.14272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta-analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta-analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study.
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Affiliation(s)
- Sebastian Probst
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Care DirectorateUniversity Hospital GenevaGeneva University HospitalsGenevaSwitzerland
- Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
| | - Camille Saini
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Géraldine Gschwind
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Alessio Stefanelli
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Paul Bobbink
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Faculty of Biology and Medicine, University Institute of Higher Education and Research in HealthcareUniversity of LausanneLausanneSwitzerland
| | - Marie‐Thérèse Pugliese
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Sezen Cekic
- Department of PsychologyUniversity of GenevaGenevaSwitzerland
| | - Damien Pastor
- Department of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
| | - Georgina Gethin
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Alliance for Research and Innovation in WoundsUniversity of GalwayGalwayIreland
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Graves N, Ganesan G, Tan KB, Goh OQ, Ho J, Chong TT, Bishnoi P, Carmody D, Yuh AS, Ng YZ, Lo Z, Enming Y, Abu Bakar Aloweni F, Zifei W, Harding K. Chronic wounds in a multiethnic Asian population: a cost of illness study. BMJ Open 2023; 13:e065692. [PMID: 37723106 PMCID: PMC10510887 DOI: 10.1136/bmjopen-2022-065692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To estimate the 'cost of illness' arising from chronic wounds in Singapore. DESIGN Incidence-based cost of illness study using evidence from a range of sources. SETTING Singapore health services. PARTICIPANTS We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated. RESULTS Total annual cost of illness was $350 million (range $72-$1779 million). With 168 503 acute bed days taken up annually (range 141 966-196 032) that incurred costs of $139 million (range 117-161 million). Total costs to health services were $184 million (range $120-$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range -2657 to 29 029) valued at $166 million (range -212 to 2399 million). CONCLUSIONS The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ganga Ganesan
- Health Services Research, Ministry of Health, Singapore
| | - Kelvin Bryan Tan
- SingHealth Duke-NUSGlobal Health Institute, Duke-NUS Medical School, Singapore
| | - Orlanda Qm Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Jackie Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Priya Bishnoi
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - David Carmody
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Yi Zhen Ng
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zhiwen Lo
- Department of Surgery, Vascular Surgery Woodlands Health, Singapore
| | - Yong Enming
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Wang Zifei
- Skin Research Institute of Singapore (SRIS), Singapore
| | - Keith Harding
- Skin Research Institute of Singapore (SRIS), Singapore
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Chan DYS, Surendra NK, Ng YZ, Lee SH, Yong E, Hong Q, Goh CC, Lai TP, Tan AHM, Law CCC, Liang S, Car J, Lo ZJ. Prospective study on the clinical and economic burden of venous leg ulcers in the tropics. J Vasc Surg Venous Lymphat Disord 2023; 11:954-963. [PMID: 37209840 DOI: 10.1016/j.jvsv.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/17/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Venous leg ulcers (VLUs) are both chronic and recurrent. The treatment of such ulcers often require multiple outpatient visits and dressing changes. Several reports on the costs of treating such VLUs have been reported in the west. We prospectively evaluated the clinical and economic burden of VLUs in a population of Asian patients in the tropics. METHODS Patients from a prospective two-center study conducted at two tertiary hospitals in Singapore, as a part of the Wound Care Innovation in the Tropics program, between August 2018 and September 2021 were recruited. The patients were followed up for 12 weeks (visit 1 to visit 12), until index ulcer healing, death, or lost to follow-up (whichever came first). These patients were then followed up 12 weeks later to determine the longer term outcome of the wound (healed, recurrence, remained unhealed). The itemized costs derived from the medical service were retrieved from the relevant departments of the study sites. The patients' health-related quality of life was assessed at baseline and the last visit of the 12-week follow-up period (or until index ulcer healing), using the official Singapore version of the EuroQol five-dimension-5L questionnaire, which also includes a visual analog scale (EQ-VAS). RESULTS A total of 116 patients were enrolled; 63% were men, and the mean patient age was 64.7 years. Of the 116 patients, 85 (73%) had a healed ulcer at 24 weeks (mean duration to ulcer healing, 49 days), and 11 (12.9%) had experienced ulcer recurrence within the study period. Within the 6-month follow-up period, the mean direct healthcare cost per patient was USD$1998. The patients with healed ulcers had significantly lower costs per patient compared with those with unhealed ulcers (USD$1713 vs USD$2780). Regarding health-related quality of life, 71% of the patients had a lower quality of life at baseline, which had improved at 12 weeks of follow-up, with only 58% of the patients reported to have a lower quality of life. Also, the patients with healed ulcers scored higher for both utilities (societal preference weights) and EQ-VAS at follow-up (P < .001). In contrast, patients with unhealed ulcers only scored higher EQ-VAS at follow-up (P = .003). CONCLUSIONS The findings from this exploratory study provide information on the clinical, quality of life, and economic burden of VLUs in an Asian population and suggest the importance of healing VLUs to reduce the effects on patients. The present study provides data as a basis for economic evaluation as a consideration for the treatment of VLUs.
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Affiliation(s)
| | - Naren Kumar Surendra
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sze-Han Lee
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Qiantai Hong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tina Peiting Lai
- Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore
| | - Audrey Hui Min Tan
- Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Shanying Liang
- Department of Surgery, Woodlands Health, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Zhiwen Joseph Lo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Surgery, Woodlands Health, Singapore, Singapore
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12
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Srivastava R, Ong EP, Tan DYY, Zhang J, Toe KK, Bishnoi P, Ng YZ, So RQY. Early Prediction of Wound Healing Outcome Based on Chronic Wound Registry Database. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082721 DOI: 10.1109/embc40787.2023.10340214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Chronic wounds cause a number of unnecessary amputations due to a delay in proper treatment. To expedite timely treatment, this paper presents an algorithm which uses a logistic regression classifier to predict whether the wound will heal or not within a specified time. The prediction is made at three time-points: one month, three months, and six months from the first visit of the patient to the healthcare facility. This prediction is made using a systematically collected chronic wound registry and is based entirely on data collected during patients' first visit. The algorithm achieves an area under the receiver operating characteristic curve (AUC) of 0.75, 0.72, and 0.71 for the prediction at the three time-points, respectively.Clinical relevance- Using the proposed prediction model, the clinicians will have an early estimate of the time taken to heal thereby providing appropriate treatments. We hope this will ensure timely treatments and reduce the number of unnecessary amputations.
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13
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Nazeha N, Lee JY, Saffari SE, Meng L, Ho P, Ng YZ, Graves N. The burden of costs on health services from patients with venous leg ulcers in Singapore. Int Wound J 2022; 20:845-852. [PMID: 36098383 PMCID: PMC9927897 DOI: 10.1111/iwj.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.
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Affiliation(s)
- Nuraini Nazeha
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | - Jia Yi Lee
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - Lingyan Meng
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Cardiac, Thoracic and Vascular SurgeryNational University Health SystemSingapore
| | - Pei Ho
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Cardiac, Thoracic and Vascular SurgeryNational University Health SystemSingapore
| | - Yi Zhen Ng
- Wound Care Innovation for the Tropics ProgrammeSkin Research Institute of Singapore, A*STARSingapore
| | - Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
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14
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Reinboldt-Jockenhöfer F, Traber J, Liesch G, Bittner C, Benecke U, Dissemond J. Concurrent optical and magnetic stimulation therapy in patients with lower extremity hard-to-heal wounds. J Wound Care 2022; 31:S12-S21. [PMID: 35678774 DOI: 10.12968/jowc.2022.31.sup6.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The treatment of patients with hard-to-heal wounds represents a major multidisciplinary challenge. Therefore, the development and clinical validation of new technologies remains extremely important. The novel application of concurrent optical and magnetic stimulation (COMS) offers a promising noninvasive approach to support physiological wound healing processes, especially in hard-to-heal wounds. METHOD In a multicentre, prospective, comparative, clinical trial, patients with hard-to-heal wounds on lower extremities of different aetiologies were treated with COMS as an adjunct to standard of care (SOC). The primary endpoint was safety; secondary endpoints were wound healing, pain and wound-specific quality of life (Wound-QoL). RESULTS A total of 40 patients were enrolled in this study (intention to treat population (ITTP), n=40). Of these patients, 37 were included in the analysis of the primary endpoint (primary endpoint population, (PEP), n=37). A further subgroup of 30 patients was included in the analysis of the secondary endpoint (secondary endpoint population (SEP), n=30). Finally, the SEP was stratified regarding patients' responsiveness to SOC in an SOC non-responder subgroup (NRSG), n=21, and in an SOC responder subgroup (RSG), n=9. A total of 102 adverse events (AEs) were recorded, of which 96% were 'mild' or 'moderate', and 91% were either a singular or transient event. Only 11 AEs were serious and associated with inpatient treatments unrelated to the studied intervention. In the NRSG, reductions in wound size were found to be statistically significant within the different study periods. Additionally, an acceleration of the healing rate was detected between the baseline and the first four weeks of COMS treatment (p=0.041). The rate of near-complete and complete wound closure in the SEP after 12 weeks were 60% and 43%, respectively. Pain reduction across the treatment group was statistically significant (p≤0.002 for both the SEP and NRSG). The Wound-QoL score improved by 24% during the study (p=0.001). CONCLUSION In this study, COMS treatment for patients with hard-to-heal wounds on lower extremities was a safe and effective novel treatment option, especially for patients who did not respond to SOC.
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Affiliation(s)
| | - Jürg Traber
- Venenklinik Bellevue, Kreuzlingen, Switzerland
| | | | | | - Ulf Benecke
- Department of Dermatology, Venereology and Allergology, University Hospital, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital, Essen, Germany
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15
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Wu YF, Lin YC, Yang HW, Cheng NC, Cheng CM. Point-of-Care Wound Blotting with Alcian Blue Grading versus Fluorescence Imaging for Biofilm Detection and Predicting 90-Day Healing Outcomes. Biomedicines 2022; 10:biomedicines10051200. [PMID: 35625936 PMCID: PMC9138671 DOI: 10.3390/biomedicines10051200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Biofilm infection has been identified as a crucial factor of the pathogenesis of chronic wound, but wound biofilm diagnosis remains as an unmet clinical need. We previously proposed a modified wound blotting technique using Alcian blue staining for biofilm detection that was characterized as being non-invasive, time-saving, non-expansive, and informative for biofilm distribution. In this study, we adapted a novel Alcian blue grading method as the severity of biofilm infection for the wound blotting technique and compared its biofilm detection efficacy with MolecuLight i:X- a point-of-care florescence imaging device to detect bacteria and biofilm in wounds. Moreover, their predictive value of complete wound healing at 90 days was analyzed. When validated with wound culture results in the 53 enrolled subjects with chronic wounds, the modified wound blotting method showed a strong association with wound culture, while MolecuLight i:X only exhibited a weak association. In predicting 90-day wound outcomes, the modified wound blotting method showed a strong association (Kendall’s tau value = 0.563, p < 0.001), and the wound culture showed a moderate association (Spearman’s rho = 0.535, p < 0.001), but MolecuLight i:X exhibited no significant association (p = 0.184). In this study, modified wound blotting with the Alcian blue grading method showed superior value to MolecuLight i:X both in biofilm detection and predictive validity in 90-day wound-healing outcomes.
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Affiliation(s)
- Yu-Feng Wu
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300, Taiwan;
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan;
| | - Yu-Chen Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan;
| | - Hung-Wei Yang
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Biomedical Park Branch, Zhubei City 302, Taiwan;
| | - Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei 100, Taiwan
- Correspondence: (N.-C.C.); (C.-M.C.)
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan;
- Correspondence: (N.-C.C.); (C.-M.C.)
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16
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Zhu X, Olsson MM, Bajpai R, Järbrink K, Tang WE, Car J. Health-related quality of life and chronic wound characteristics among patients with chronic wounds treated in primary care: A cross-sectional study in Singapore. Int Wound J 2021; 19:1121-1132. [PMID: 34854234 PMCID: PMC9284657 DOI: 10.1111/iwj.13708] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
Chronic wounds commonly decrease patients' quality of life. Understanding how chronic wounds impact a patient's health‐related quality of life (HRQoL) is important for healthcare service delivery and treatment management. This study explored HRQoL among patients suffering from chronic wounds and investigated associations with patients' socio‐demographics and wound characteristics. Two hundred and thirty‐three patients across six primary care clinics were assessed and responded to a survey that collected information on socio‐demographic, wound characteristics, and HRQoL using the EQ‐5D‐5L instrument. Data were analysed by descriptive statistics and generalised linear models. The mean age of patients was 61.2 (SD: 14.6) years; 68.2% were males; and 61.8% were of Chinese origin. Arterial ulcers had the greatest negative impact on HRQoL related to mobility, self‐care, pain/discomfort and anxiety/depression, and the lowest VAS mean score 62.31 (SD: 28.3; range: 0‐100) indicating the worst health. HRQoL related to mobility was significantly associated with age (β = 0.008, P < .001), non‐Chinese ethnicity (β = 0.25, P = .001), mixed ulcers (β = −0.41, P = .022), atypical hard‐to‐heal wounds (β = −0.38, P = .021), wounds with low (β = 0.24, P = .044) to moderate (β = 0.29, P = .018) exudate level, and a wound duration ≥6 months (β = 0.19, P = .033). The findings can be used to improve healthcare delivery for patients with chronic wound to optimise their HRQoL.
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Affiliation(s)
- Xiaoli Zhu
- Nursing Services, National Healthcare Group Polyclinics, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Maja Magdalena Olsson
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,School of Medicine, Keele University, Staffordshire, UK
| | - Krister Järbrink
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wern Ee Tang
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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17
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Khoo VB, Soon S, Yap CJ, Chng SP, Tang TY. Use of Blue Light in the Management of Chronic Venous Ulcer in Asian Patients: A Case Series. Cureus 2021; 13:e17703. [PMID: 34650877 PMCID: PMC8489597 DOI: 10.7759/cureus.17703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/05/2022] Open
Abstract
Chronic venous ulcers, often complicated by late diagnosis and persistent infections, present major clinical and financial challenges. Recently, photobiomodulation therapy (PBMT) has been shown to be effective in overcoming physiological impairments such as hemostasis and inflammation, accelerating the wound healing process. This case series summarises our experience in the treatment of two Asian patients with lower-extremity chronic venous ulcers using PBMT with blue light. Case 1 was a 71-year-old male with a history of hypertension, chronic venous insufficiency and previous deep vein thrombosis. Prior to blue light therapy, the average duration of treatment until wound closure with compression dressings used to be 10-12 weeks. Complete wound closure with the blue light therapy was eight weeks, with a total reduction of 67% of wound size by week 4. Case 2 was a 77-year-old male with a background of hypertension and ischaemic heart disease. Prior to blue light therapy, the patient had also underwent iliac venoplasty and stenting for his recurring bilateral malleolus venous ulcers. By week 4, the right malleolus wound had healed, while the left malleolus wound had a size reduction of 38%. Complete closure of both the wounds was noted at week 6. Blue light was administered to the wounds of both patients for 120 seconds per session, as an adjunct to compression therapy. Both patients reported no additional wound pain during the administration of blue light therapy, with an overall reduction of wound pain at three weeks. The cases demonstrated that PBMT with blue light was well-tolerated, safe, and efficacious in improving wound healing with an adjunct to standard treatment of chronic venous ulcers.
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Affiliation(s)
- Vanessa B Khoo
- Department of Vascular Surgery, Singapore General Hospital, Singapore, SGP
| | - Shereen Soon
- Department of Vascular Surgery, Singapore General Hospital, Singapore, SGP
| | - Charyl J Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore, SGP
| | - Siew Ping Chng
- Department of Vascular Surgery, Singapore General Hospital, Singapore, SGP
| | - Tjun Y Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, SGP
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18
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Kwek MSY, Thangaveloo M, Hui SLB, Madden LE, Phillips AR, Becker DL. Characterisation of an ischemia reperfusion model for the formation of a stage I pressure ulcer in mouse skin. J Tissue Viability 2021; 30:352-362. [PMID: 33875344 DOI: 10.1016/j.jtv.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/09/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Pairs of magnets were applied to the loose skin on the backs of mice in order to cause ischemia for periods of 1.5, 2, 2.5 and 3 h followed by reperfusion. We found 1.5 h of ischemia resulted in the most reliable outcome of blanched skin but no redness or skin breakdown. Histological analysis at 4 h of reperfusion showed, in the centre of the insult, condensed nuclei in the epidermis and sebaceous glands with a build up of neutrophils in the blood vessels, and a reduction in the number of fibroblasts. At 24 h, spongiosis was seen in the epidermis and pockets of neutrophils began to accumulate under it, as well as being scatted through the dermis. In the centre of the insult there was a loss of sebaceous gland nuclei and fibroblasts. Four days after the insult, spongiosis was reduced in the epidermis at the edge of the insult but enhanced in the centre and in hair follicles. Leukocytes were seen throughout the central dermis. At 8 days, spongiosis and epidermal thickness had reduced and fibroblasts were reappearing. However, blood vessels still had leukocytes lining the lumen. The gap junction protein connexin 43 was significantly elevated in the epidermis at 4 h and 24 h reperfusion. Ischemia of 1.5 h generates a sterile inflammatory reaction causing the loss of some cell types but leaving the epidermis intact reminiscent of a stage I pressure ulcer.
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Affiliation(s)
- Milton Sheng Yi Kwek
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | - Sophia Lim Beng Hui
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | - Leigh E Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | | | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore.
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